Risk Factors for Sepsis-Associated Acute Kidney Injury in the PICU: A Retrospective Cohort Study

Ninmer, Emily K.; Charlton, Jennifer R.; Spaeder, Michael C.

doi:10.1097/pcc.0000000000002957

Cited by 2 publications

(1 citation statement)

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“…On first assessment, the 39% of patients on day 7 with severe AKI (18/46) appears higher than reported prevalence of 10.0% with severe AKI at a similar timepoint in the Assessment of Worldwide Acute Kidney Injury, Renal Angina and Epidemiology in criticall ill children (AWARE) study ( n = 4683) (9); readers should note that three patients admitted between February and May 2014 were incorporated into both studies. Because the rates of AKI exceed those reported in other cohorts with acute illness, including sepsis (27–29), we believe that children with ALF are at increased risk of AKI. Notably, 22 of 46 PALF patients still admitted to PICU on day 7, progressed to AKD.…”

Section: Discussionmentioning

confidence: 69%

Prevalence, Associated Factors, and Outcomes of Severe Acute Kidney Injury in Pediatric Acute Liver Failure: Single-Center Retrospective Study, 2003–2017

Alexander,

Saxena,

Singla

et al. 2024

Pediatric Critical Care Medicine

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Objectives: Our aim was to determine the prevalence and explanatory factors associated with outcomes in children with acute liver failure (ALF) admitted to the PICU, who also develop severe acute kidney injury (AKI). Design: Retrospective cohort, 2003 to 2017. Setting: Sixteen-bed PICU in a university-affiliated tertiary care hospital. Patients: Admissions to the PICU with ALF underwent data review of the first week and at least 90-day follow-up. Patients with stages 2–3 AKI using the British Association of pediatric Nephrology definitions, or receiving continuous renal replacement therapy (CRRT) for renal indications, were defined as severe AKI. We excluded ALF cases on CRRT for hepatic-only indications. Interventions: None. MEASUREMENTS AND MAIN RESULTS: Baseline characteristics, proportion with severe AKI, illness severity and interventions, and outcomes (i.e., transplant, survival with native liver, overall survival, duration of PICU stay, and mechanical ventilation).Ninety-four children with ALF admitted to the PICU were included. Over the first week, 29 had severe AKI, and another eight received CRRT for renal/mixed reno-hepatic indications; hence, the total severe AKI cohort was 37 of 94 (39.4%). In a multivariable logistic regression model, peak aspartate aminotransferase (AST) and requirement for inotropes on arrival were associated with severe AKI. Severe AKI was associated with longer PICU stay and duration of ventilation, and lower spontaneous survival with native liver. In another model, severe AKI was associated with greater odds of mortality (odds ratio 7.34 [95% CI, 1.90–28.28], p = 0.004). After 90 days, 3 of 17 survivors of severe AKI had serum creatinine greater than the upper limit of normal for age. Conclusions: Many children with ALF in the PICU develop severe AKI. Severe AKI is associated with the timecourse of PICU admission and outcome, including survival with native liver. Future work should look at ALF goal directed renoprotective strategies at the time of presentation.

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Section: Discussionmentioning

confidence: 69%