# Secondary Cardiorenal Syndrome in a Cohort of Septic Patients Treated in a Medical Intensive Care Unit: A Single-Center Experience

## TL;DR

This study examines how factors like blood pressure and health scores affect outcomes in septic patients with heart and kidney failure.

## Contribution

The study identifies key predictors of mortality in septic patients with secondary cardiorenal syndrome.

## Key findings

- 66% of patients with sepsis and type five CRS died during hospitalization.
- Low systolic blood pressure and higher APACHE II scores predicted worse outcomes.
- Shorter hospital stays were associated with higher mortality rates.

## Abstract

Context

Sepsis is a life-threatening condition caused by an abnormal host response to infection, resulting in multiple organ failure and high mortality rates. Secondary or type five cardiorenal syndrome (CRS) emerges as a consequence of systemic infection, resulting in both cardiac and renal dysfunction. The synergistic impact of inflammation and hemodynamic instability results in an adverse cycle of vital organs damage during which renal impairment further aggravates cardiac dysfunction and vice versa.

Objectives

The objective of this study is to assess the influence of specified demographic, clinical, and laboratory parameters on the hospitalization outcome of patients who fulfilled CRS-5/Sepsis-3/KDIGO (Kidney Disease: Improving Global Outcomes) criteria treated in the intensive care unit (ICU) from March 2022 to September 2024 (30 months).

Methods

The observational study comprised 41 patients treated at Zemun University Clinical Hospital's medical ICU (mICU). The inclusion criteria were a positive blood culture, elevated procalcitonin (Pct) levels, and clinical and laboratory evidence of heart and renal failure in the presence of sepsis. The cohort of patients was divided into two groups (survivors and deaths) based on hospitalization outcomes. Epidemiological (gender, age, duration of hospital stay), clinical (systolic blood pressure (SBP) and diastolic blood pressure (DBP), ejection fraction (EF), Acute Physiology and Chronic Health Evaluation II (APACHE II) score, the presence of disseminated intravascular coagulation (DIC) and the use of renal replacement therapy (RRT)), and laboratory (white blood cells (WBC) and platelet (Plt) counts, the levels of C-reactive protein (CRP), D-dimer, Pct, urea, creatinine, B-type natriuretic peptide (BNP), troponin (Tn)) parameters were examined. The obtained data were analyzed using the statistical package SPSS for Windows 22.0.

Results

The study cohort had an average age of 70 years (43-84 years), with 22 (54%) female patients. Out of 41 patients, 14 (34%) survived and 27 (66%) died. The values of SBP and APACHE II score, as well as the duration of hospital stay, statistically differed between the two groups (p=0.009, p=0.000, and p=0.000, respectively) and had a significant impact on hospitalization outcome (p=0.007, p=0.000, and p=0.000, respectively).

Conclusion

According to the findings, patients with sepsis and type five CRS had a significant mortality rate (66%). Low SBP, a higher APACHE II score, and a shorter duration of hospital stay are significant predictors of unfavorable outcomes. Additional research and the development of clinical guidelines are required to improve the prognosis of such patients.