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Association of infections and venous thromboembolism in hospitalized children with nephrotic syndrome

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Abstract

Background

Nephrotic syndrome (NS) results in hypercoagulability and increased risk of infection. Furthermore, infection increases the risk of venous thromboembolism (VTE). Our objective was to determine the prevalence of infection, VTE, and the associated outcomes among a cohort of hospitalized children with NS.

Methods

All children with NS admitted to 17 pediatric hospitals across North America from 2010 to 2012 were included. Prevalence of infection and VTE was determined. Wilcoxon rank-sum and logistic regression were performed.

Results

Seven-hundred thirty hospitalizations occurred among 370 children with NS. One-hundred forty-eight children (40%) had ≥ 1 infection (211 episodes) and 11 (3%) had VTE. Those with VTE had infection more frequently (p = 0.046) and were younger at NS diagnosis (3.0 vs. 4.0 years; p = 0.008). The most common infectious pathogen identified was Streptococcus pneumoniae. The median hospital length of stay for those with infection [10 vs 5 days (p < 0.0001)] or VTE [22 vs 6 days (p < 0.0001)] was longer than those without either complication. Of those with infection, 13% had an intensive care unit (ICU) stay compared with 3.3% of those without infection. Median ICU stay was 4 days in those with VTE compared to 0 days in those without (p < 0.001). By logistic regression, only the number of ICU days was associated with VTE (OR 1.074, 95% CI 1.013–1.138).

Conclusions

Hospitalized children with NS have high rates of infection. Presence of VTE was associated with infection. Both were associated with longer hospitalizations and ICU stays.

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Author information

Authors and Affiliations

  1. Children’s Mercy Hospital, Kansas City, MO, USA

    Shannon L. Carpenter, Jennifer Goldman & Ashley K. Sherman

  2. University of Michigan, Ann Arbor, MI, USA

    David T. Selewski

  3. Nationwide Children’s Hospital, Columbus, OH, USA

    Mahmoud Kallash, William E. Smoyer & Bryce A. Kerlin

  4. Mayo Clinic, Rochester, MN, USA

    Cheryl L. Tran

  5. University of Utah, Salt Lake City, UT, USA

    Meredith Seamon

  6. University of Miami Miller School of Medicine, Miami, FL, USA

    Chryso Katsoufis

  7. LSU Health Sciences Center, New Orleans, LA, USA

    Isa Ashoor

  8. Kaiser Permanente, Los Angeles, CA, USA

    Joel Hernandez

  9. Stony Brook Children’s Hospital, Stony Brook, NY, USA

    Katarina Supe-Markovina

  10. Connecticut Children’s Hospital, Hartford, CT, USA

    Cynthia D’alessandri-Silva

  11. University of Puerto Rico, San Juan, Puerto Rico

    Nilka DeJesus-Gonzalez

  12. Texas Tech University Health Sciences Center, Amarillo, TX, USA

    Tetyana L. Vasylyeva

  13. Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA

    Cassandra Formeck

  14. Yale School of Medicine, New Haven, CT, USA

    Christopher Woll

  15. Duke University, Durham, NC, USA

    Rasheed Gbadegesin

  16. Children’s Hospital of Eastern Ontario, Ottawa, Ontario, USA

    Pavel Geier

  17. Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

    Prasad Devarajan

  18. University of Minnesota Masonic Children’s Hospital, Minneapolis, MN, USA

    Michelle N. Rheault

  19. Division of Pediatric Nephrology, University of Minnesota, 2450 Riverside Ave. MB680, Minneapolis, MN, 55454, USA

    Michelle N. Rheault

Authors
  1. Shannon L. Carpenter
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  2. Jennifer Goldman
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  3. Ashley K. Sherman
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  4. David T. Selewski
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  5. Mahmoud Kallash
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  6. Cheryl L. Tran
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  7. Meredith Seamon
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  8. Chryso Katsoufis
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  9. Isa Ashoor
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  10. Joel Hernandez
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  11. Katarina Supe-Markovina
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  12. Cynthia D’alessandri-Silva
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  13. Nilka DeJesus-Gonzalez
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  14. Tetyana L. Vasylyeva
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  15. Cassandra Formeck
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  16. Christopher Woll
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  17. Rasheed Gbadegesin
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  18. Pavel Geier
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  19. Prasad Devarajan
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  20. William E. Smoyer
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  21. Bryce A. Kerlin
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  22. Michelle N. Rheault
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Corresponding author

Correspondence to Michelle N. Rheault.

Ethics declarations

The Institutional Review Board at each institution approved the study.

Conflict of interest

The authors declare that they have no conflict of interest.

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Carpenter, S.L., Goldman, J., Sherman, A.K. et al. Association of infections and venous thromboembolism in hospitalized children with nephrotic syndrome. Pediatr Nephrol 34, 261–267 (2019). https://doi.org/10.1007/s00467-018-4072-6

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  • DOI: https://doi.org/10.1007/s00467-018-4072-6

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