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Risk factors and inpatient outcomes associated with acute kidney injury at pediatric severe sepsis presentation

  • Julie C. Fitzgerald
  • Michelle E. Ross
  • Neal J. Thomas
  • Scott L. Weiss
  • Fran Balamuth
  • Amanda Hyre Anderson
Original Article

Abstract

Background

Little data exist on acute kidney injury (AKI) risk factors in pediatric sepsis. We identified risk factors and inpatient outcomes associated with AKI at sepsis recognition in children with severe sepsis.

Methods

Retrospective, cross-sectional study with inpatient outcome description of 315 patients > 1 month to < 20 years old with severe sepsis in a pediatric intensive care unit over 3 years. Exposures included demographics, vitals, and laboratory data. The primary outcome was kidney disease: Improving Global Outcomes creatinine-defined AKI within 24 h of sepsis recognition. Factors associated with AKI and AKI severity were identified using multivariable Poisson and multinomial logistic regression, respectively.

Results

AKI was present in 42% (133/315) of severe sepsis patients, and 26% (83/315) had severe (stage 2/3) AKI. In multivariable-adjusted analysis, hematologic/immunologic comorbidities, malignancies, chronic kidney disease (CKD), abdominal infection, admission illness severity, and minimum systolic blood pressure (SBP) ≤ 5th percentile for age and sex within 24 h of sepsis recognition were associated with AKI. Factors associated with mild AKI were CKD and abdominal infection, while factors associated with severe AKI were younger age, hematologic/immunologic comorbidities, malignancy, abdominal infection, and minimum SBP ≤ 5th percentile. Patients with AKI had increased hospital mortality (17 vs. 8%, P = 0.02) and length of stay [median 20 (IQR 10–47) vs. 16 days (IQR 7–37), P = 0.03].

Conclusions

In pediatric severe sepsis, AKI is associated with age, comorbidities, infection characteristics, and hypotension. Future evaluation of risk factors for AKI progression during sepsis is warranted to minimize AKI progression in this high-risk population.

Keywords

Acute kidney injury Sepsis Child Risk factors Pediatric intensive care units 

Notes

Funding information

This study was supported by the Division of Critical Care Medicine Russell Raphaely Endowed Chair of Critical Care Medicine at the Children’s Hospital of Philadelphia.

Compliance with ethical standards

Conflict of interest

Dr. Weiss is supported by NIH K23GM110496. Dr. Balamuth received career development support from NICHD K23-HD082368. Dr. Anderson is supported by NIH R01DK104730 and R01DK107566. Drs. Fitzgerald, Ross, and Thomas declare they have no conflicts of interest.

Research involving human participants and/or animals

This study was approved by the Children’s Hospital of Philadelphia Institutional Review Board and was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.

Informed consent

This retrospective study was performed under a waiver of consent by the Institutional Review Board.

Supplementary material

467_2018_3981_MOESM1_ESM.docx (43 kb)
ESM 1 (DOCX 43 kb)

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Copyright information

© IPNA 2018

Authors and Affiliations

  1. 1.Department of Anesthesiology and Critical Care MedicineChildren’s Hospital of PhiladelphiaPhiladelphiaUSA
  2. 2.Department of Anesthesiology, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaUSA
  3. 3.Department of Biostatistics, Epidemiology, and Informatics, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaUSA
  4. 4.Department of Pediatrics, Penn State Hershey Children’s HospitalPenn State University College of MedicineHersheyUSA
  5. 5.Department of Pediatrics, Division of Emergency MedicineChildren’s Hospital of PhiladelphiaPhiladelphiaUSA
  6. 6.Department of Pediatrics, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaUSA

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