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Publication Title

Journal of Emergency and Critical Care Medicine



The American healthcare system spends a large amount of economic and human resources on fighting acute sepsis. Even with years of research, mortality rates remain high. Reducing mortality outcomes from sepsis by elucidating biomarkers and the role secondary comorbidities play could assist in sepsis triage and improve outcomes in septic patients. The purpose of this study is to assess to what degree one secondary comorbidity, acute kidney failure, contributes to mortality rates among acutely septic patients in a rural Midwestern hospital located in southwest Missouri.


Cohort study assessing septic patients with and without acute kidney injuries (AKIs). ICD10 codes were submitted by physicians into Freeman Health System’s Electronic Medical Records and gathered from January 2019 to June of 2020. Those cases were filtered by secondary diagnosis resulting in two comparison groups, one sepsis only group and one sepsis with acute kidney failure not otherwise specified (NOS) group, as defined by ICD10 codes. The data was analyzed for mortality outcomes looking at secondary diagnosis, age, and sex as variables.


There were 1,122 septic patients in our study, with over 58% having a secondary diagnosis of acute kidney failure. There was a difference in the average mortality rates between patients with sepsis (16.59%) vs. those with sepsis and acute kidney failure (25.68%). We found the probable difference in mortality rate to be significant with a P value =0.003. We are 95% confident that the mortality is between 4.3% and 13.8% higher in acute kidney NOS patients. There was no significant mortality difference found when sex and aged 65 years and older were included as variables.


Specific to our sample, septic patients with a diagnosis of acute kidney NOS are at a higher risk of mortality than those without acute kidney NOS, irrespective of age or sex. Our study provides insights into variables affecting sepsis outcomes in a rural Midwestern population. Further studies are warranted into individual comorbidities affecting sepsis patient outcomes. Conclusions made here are specific to our sample; the role of acute kidney failure in the outcomes of septic patients should be further investigated in rural areas throughout the country.



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Sepsis, renal failure, acute kidney injury (AKI), rural, Midwest