Outcome of pediatric acute kidney injury: a multicenter prospective cohort study

Kari, Jameela A.; Alhasan, Khalid; Shalaby, Mohamed; Khathlan, Norah; Safdar, Osama Y; Rezgan, Suleman A. Al; Desoky, Sherif El; Albanna, Amr S.

doi:10.1007/s00467-017-3786-1

Cited by 36 publications

(24 citation statements)

References 29 publications

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“…MOF was associated with mortality in the univariate analysis, as previously reported . The presence of AKI during PICU stay reached statistical significance, confirming current knowledge about critically ill patients and in particular about oncologic ones . On the contrary, AKI at admission has not been previously reported as a predictor of mortality for oncologic patients.…”

Section: Discussionsupporting

confidence: 86%

Predictors of mortality after admission to pediatric intensive care unit in oncohematologic patients without history of hematopoietic stem cell transplantation: A single‐center experience

Pillon

Sperotto

Zattarin

et al. 2019

Pediatric Blood & Cancer

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contributed equally to the work.This work was previously published as a meeting abstract: "Risk factors and outcomes related to pediatric intensive care unit admission of oncohematologic patients without history of hematopoietic stem cell transplantation: a single center experience." Poster Presentation and Publication in Hematology Reports 2018;10:s1,p74, The XLII Congress of the Pediatric Hematology and Oncology Italian Association (AIEOP), AbstractBackground: Pediatric oncohematologic patients are a high-risk population for clinical deterioration that might require pediatric intensive care unit (PICU) admission. Several studies have described outcomes and mortality predictors for patients post hematopoietic stem cell transplantation (HSCT), but fewer data exist regarding the category of non-HSCT patients.Procedure: All oncohematologic non-HSCT patients ≤18 years requiring PICU admission from 1998 to 2015 in our tertiary-care academic hospital were retrospectively evaluated by means of the pediatric hematology-oncology unit database and the Italian PICUs data network database.We assessed the relation between demographic and clinical characteristics and 90-day mortality after PICU admission. Results:Of 3750 hospitalized oncohematologic patients, 3238 were non-HSCT and 63 (2%) of them were admitted to the PICU. Patients were mainly affected by hematological malignancies (70%) and mostly were in the induction-therapy phase. The main reasons for admission were respiratory failure (40%), sepsis (25%), and seizures (16%). The median PICU stay was 5 days (range 1-107). The mortality rate at PICU discharge was 30%, and at 90 days it was 35%. Fifty-five percent of deaths happened in the first 2 days of the PICU stay. Cardiac arrest (P = .007), presence of disseminated intravascular coagulation (DIC, P = .007), and acute kidney injury (AKI) at PICU admission (P < .001) and during PICU stay (P = .021) were significant predictors of mortality in the multivariate analysis. Respiratory failure and mechanical ventilation were not associated with mortality. Conclusions:A relatively small percentage of non-HSCT patients required PICU admission, but the mortality rate was still high. Hemodynamic instability, DIC, and AKI, but not respiratory failure, were significant predictors of mortality.

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Section: Discussionsupporting

confidence: 86%

Predictors of mortality after admission to pediatric intensive care unit in oncohematologic patients without history of hematopoietic stem cell transplantation: A single‐center experience

Pillon

Sperotto

Zattarin

et al. 2019

Pediatric Blood & Cancer

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“…Acute kidney injury (AKI) is observed in up to 30% of the children admitted to a pediatric intensive care unit (PICU) [1]. Approximately 5% of the intensive care patients will be treated with renal replacement therapy.…”

Section: Introductionmentioning

confidence: 99%

Hemodynamic impact of the connection to continuous renal replacement therapy in critically ill children

et al. 2018

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BackgroundContinuous renal replacement therapy (CRRT) is the treatment of choice for critically ill children with acute kidney injury. Hypotension after starting CRRT is frequent but very few studies have analyzed its incidence and clinical relevance.MethodsA prospective, observational study was performed including critically ill children treated with CRRT between 2010 and 2014. Hemodynamic data and connection characteristics were collected before, during, and 60 min after CRRT circuit connection. Hypotension with the connection was defined as a decrease in > 20% of the mean arterial pressure from baseline or when intravenous fluid resuscitation or an increase in vasopressors was required.ResultsOne hundred sixty-one connections in 36 children (median age 18.8 months) were analyzed. Twenty-eight patients (77.8%) were in the postoperative period of cardiac surgery, 94% had mechanical ventilation, and 86.1% had vasopressors. The heparinized circuit priming solution was discarded in 8.7% and infused to the patient in 18% of the connections. The circuit was re-primed in the remaining 73.3% using albumin (79.3%), red blood cells (4.5%), or another crystalloid solution without heparin (16.2%). Hypotension occurred in 49.7% of the connections a median of 5 min after the beginning of the therapy. Fluid resuscitation was required in 38.5% and the dose of vasopressors was increased in 12.4% of the connections. There was no relationship between hypotension and age or weight. Re-priming the circuit with albumin reduced the incidence of hypotension from 71.4 to 44.6% (p = 0.004).ConclusionsHypotension after the connection to CRRT is very frequent in critically ill children. Re-priming the circuit with albumin could improve hemodynamics during connection.

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“…Excluding patients undergoing cardiovascular surgery or transplant, studies have reported increased length of hospital stay: 9.7 days in AKI patients versus 4.6 days in non-AKI patients [31]. The AKI diagnosis may increase hospital stay by up to 10 days [32]. In this study, an increase in the maximum AKI stage conferred an incremental length of PICU stay.…”

Section: Discussionmentioning

confidence: 56%

Acute renal failure in children. Multicenter prospective cohort study in medium-complexity intensive care units from the Colombian southeast

et al. 2020

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Background Acute kidney injury is frequent in critically ill children; however, it varies in causality and epidemiology according to the level of patient care complexity. A multicenter prospective cohort study was conducted in four medium-complexity pediatric intensive care units from the Colombian southeast aimed to estimate the clinical prognosis of patients with diagnosis of acute kidney injury. Methods We included children >28 days and <18 years of age, who were admitted with diagnosis of acute kidney injury classified by Kidney Disease Improving Global Outcomes (KDIGO), during the period from January to December 2017. Severe acute kidney injury was defined as stage 2 and stage 3 classifications. Maximum KDIGO was evaluated during the hospital stay and follow up. Length of hospital stay, use of mechanical ventilation and vasoactive drugs, use of renal replacement therapy, and mortality were assessed until discharge. Results Prevalence at admission of acute kidney injury was 5.2% (95%CI 4.3% to 6.2%). It was found that 71% of the patients had their maximum KDIGO on day one; an increment in the maximum stage of acute kidney injury increased the pediatric intensive care unit stay. Patients with maximum KDIGO 3 were associated with greater use of mechanical ventilation (47%), compared with maximum KDIGO 2 (37%) and maximum KDIGO 1 (16%). Eight

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Outcome of pediatric acute kidney injury: a multicenter prospective cohort study

Abstract: One-third of PICU admissions were complicated with AKI. AKI was associated with increased hospital mortality and the length of stay in both PICU and hospital.

Cited by 36 publications

References 29 publications

Predictors of mortality after admission to pediatric intensive care unit in oncohematologic patients without history of hematopoietic stem cell transplantation: A single‐center experience

Predictors of mortality after admission to pediatric intensive care unit in oncohematologic patients without history of hematopoietic stem cell transplantation: A single‐center experience

Hemodynamic impact of the connection to continuous renal replacement therapy in critically ill children

Acute renal failure in children. Multicenter prospective cohort study in medium-complexity intensive care units from the Colombian southeast

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