Prompting With Checklist for Early Recognition and Treatment of Acute Illness On The Prevention of Acute Kidney Injury in Patients With Septic Shock

Abstract Background: Early identification of septic patients at high risk for acute kidney injury (AKI), followed by timely and appropriate interventions, is crucial for improving patients’ outcomes. Checklist for Early Recognition and Treatment of Acute Illness (CERTAIN) is a tool for evaluating and treating acute illness promptly based on best practices. We hypothesized that the use of CERTAIN would prevent the occurrence of AKI after septic shock. Methods: This was a before-and-after study. CERTAIN, included the care bundles recommended in the Sepsis 3.0 and Kidney Disease: Improving Global Outcomes (KDIGO) 2012 guidelines, used in daily practice to manage patients with septic shock. The primary outcome was the incidence of AKI within 72 hours in patients with septic shock. Secondary outcomes were mortality and major adverse kidney events (MAKEs) at 90 days after exposure to AKI. Results: 124 patients had been treated with CERTAIN, and 112 patients were in the Pre-CERTAIN group. AKI reduced significantly in the Post-CERTAIN group compared to the Pre-CERTAIN group within 72h after enrollment (55.7% vs 68.8%, P=0.045). CERTAIN prolonged ventilator-free days and vasoactive agents free days at 28 days (22 vs 17, P<0.001; 23 vs 19, P=0.044; respectively). The mortality and MAKEs at 90 days were reduced in the Post-CERTAIN group compared to the Pre-CERTAIN group (17.7% vs 29.5%, P=0.045; 41.9% vs 56.3%, P=0.039; respectively). Conclusions: Implementation of CERTAIN reduced the AKI frequency, mortality at 90 days, and the rate of MAKEs at 90 days in septic shock patients. Trial registration: NCT01973829. Date of registration: 1st November 2013.