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In a previous issue of Critical Care, we read with interest the article by Japiassu and colleagues [1] in which severe sepsis was analyzed as a major determinant of outcome of critically ill patients with HIV/AIDS. For this purpose, the authors prospectively studied 88 HIV-infected patients admitted to the intensive care unit and analyzed the impact of severe sepsis on 28-day and 6-month mortality. Th e occurrence of severe sepsis was associated with a threefold increased risk of death at these follow-up times. Furthermore, cardiovascular and respiratory dysfunc tions were associated with increased mortality. Th ose are important fi ndings and improve medical knowledge on the key factors determining survival in a specifi c population that has markedly increased in recent years [2]. Surprisingly, however, the authors have not evaluated the impact of renal dysfunction on patient outcome. Here, we would like to underline the prognostic importance of acute kidney injury (AKI) on the outcome of critically ill patients with HIV. AKI is a common complication in this setting and is independently associated with increased mortality. In addition, sepsis is a leading cause of AKI among those patients [3]. Th ese fi ndings have also been demonstrated in non-critically ill, hospital ized patients with HIV [4]. Th erefore, the burden of mortality associated with sepsis could be explained, in part, by the high incidence of associated AKI. Prompt recognition and aggressive treatment of sepsis could be crucial in diminishing both the occurrence of AKI and mortality in critically ill patients with HIV.

Sepsis as a major determinant of outcome in critically ill HIV/AIDS patients: don't forget acute kidney injury