Acute Kidney Injury in Pediatric Severe Sepsis: An Independent Risk Factor for Death and New Disability

Abstract

Objective The prevalence of septic acute kidney injury (AKI) and impact on functional status of pediatric intensive care unit (PICU) survivors are unknown. We utilized data from an international prospective severe sepsis study to elucidate functional outcomes of children suffering septic AKI. Design Secondary analysis of patients in the Sepsis PRevalence, OUtcomes, and Therapies (SPROUT) point prevalence study. AKI was defined on the study day using Kidney Disease Improving Global Outcomes definitions. Patients with no AKI or stage 1 AKI (“No/mild AKI”) were compared to those with stage 2 or 3 AKI (“Severe AKI”). The primary outcome was a composite of death or new moderate disability at discharge defined as a Pediatric Overall Performance Category score of 3 or higher, and increased by 1 from baseline. Setting 128 PICUs in 26 countries. Patients Children with severe sepsis in the SPROUT study. Interventions None Measurements and Main Results One hundred two (21%) of 493 patients had Severe AKI. More than twice as many patients with Severe AKI died or developed new moderate disability compared to those with No/mild AKI (64% vs. 30%, p<0.001). Severe AKI was independently associated with death or new moderate disability (adjusted OR 2.5, 95% CI 1.5, 4.2; p=0.001) after adjustment for age, region, baseline disability, malignancy, invasive mechanical ventilation, albumin administration, and the pediatric logistic organ dysfunction score. Conclusions In a multi-national cohort of critically ill children with severe sepsis and high mortality rates, septic AKI is independently associated with further increased death or new disability.

Pediatric continuous renal replacement therapy: have practice changes changed outcomes? A large single-center ten-year retrospective evaluation

“…Since the ppCRRT registry was concluded more than ten years ago, the pediatric nephrology and critical care communities gained a wealth of information, including data on the demographics, epidemiologic, and technical aspects of pediatric CRRT [ 25 ]. The field of AKI clinical research has exploded in the last decade, improving our understanding of the impact of AKI on survival as well as other morbidity such as new disability [ 55 ]. While feasibility of pediatric CRRT was still being questioned in the early 2000s, it has now become the standard of care.…”

Acute kidney injury is a common complication in children and adolescents hospitalized for diabetic ketoacidosis

“…We defined stage 0 AKI as a creatinine level <1.5 times the EBC, stage 1 AKI as creatinine level 1.5 to 2 times the EBC, stage 2 AKI as creatinine level 2 to 3 times the EBC, and stage 3 AKI as creatinine level >3 times the EBC. Patients were further divided into three groups: no AKI (stage 0 AKI), mild AKI (stage 1 AKI), and severe AKI (stage 2 and 3 AKI); stages 2 and 3 AKI were associated with higher mortality rates in children [16,17]. Corrected sodium (Na) was calculated using the following formula: corrected Na = Serum Na + (1.6 mEq/L Na + for every 100 mg/dL glucose in excess of 100) [18].…”

Prognosis and Early Prediction of Acute Kidney Injury in Critically Ill Children

“…The sepsis associated AKI is also assumed to proceed chronic renal failure more frequently (28). We could not determine any statistically significant relationship between the accompanying infection and the development of AKI, however, initial procalcitonin and CRP levels at admission to PICU were higher in patients with AKI.…”

“…Severe AKI is reported nearly in 20% of patients presenting with sepsis. The mortality of the septic AKI is reported to be three times higher when compared with nonseptic AKI in adults (28).…”