Acute Kidney Injury in Critically Ill Patients with Cutaneous-origin Sepsis: A Systematic Review

Abstract

Aims: This systematic review aims to synthesize current evidence regarding the incidence, clinical progression, and therapeutic management of acute kidney injury (AKI) in adult patients with sepsis originating from severe dermatologic infections. It emphasizes the clinical significance of cutaneous-origin sepsis, the role of risk factors such as hypotension and inflammatory markers, and the importance of a multidisciplinary approach involving nephrology, dermatology, and infectious disease. Study Design: Systematic literature review. The review followed PRISMA guidelines. Place and Duration of Study: Databases searched (PubMed, SciELO, LILACS, BVS, MEDLINE) between January 2014 and April 2024. Methodology: The review followed PRISMA guidelines. Studies published between 2014 and 2024 were included if they addressed AKI in the context of dermatologic-origin sepsis. Eligible study designs included observational studies, case series, and clinical reports in English, Portuguese, or Spanish. Data extraction was performed independently by two reviewers using a standardized form. Quality assessment used the Newcastle-Ottawa Scale (NOS) and JBI checklist, depending on study type. Results: A total of 582 studies were initially identified, with 14 meeting all eligibility criteria. Included studies involved 2,761 adult ICU patients with infections such as deep cellulitis, necrotizing fasciitis, infected ulcers, and burns. AKI incidence ranged from 21.4% to 64.7%. The presence of AKI was associated with increased need for renal replacement therapy (RRT), longer hospital stays, and higher mortality. Risk factors for poor renal outcomes included sustained hypotension, early vasopressor use, elevated lactate and procalcitonin levels, and persistent oliguria. Common interventions included early antibiotic therapy, volume resuscitation, avoidance of nephrotoxins, and the use of CRRT in unstable patients. Conclusion: Sepsis of dermatologic origin poses a substantial risk for AKI development, with clinical and mortality impacts comparable to other septic sources. Early identification and integrated multidisciplinary management are crucial for improving renal outcomes. Further prospective and multicenter research is needed to refine diagnostic tools and intervention protocols specific to this high-risk population.