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Kidney Week

Abstract: TH-OR111

AKI in Pediatric Sepsis Is an Independent Risk Factor for Death and New Substantive Disability

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • Starr, Michelle C., Seattle Children's Hospital, Seattle, Washington, United States
  • Reeder, Ron W., University of Utah, Salt Lake City, Utah, United States
  • Zimmerman, Jerry J., Seattle Children''s Hospital, University of Washington School of Medicine, Seattle, Washington, United States
  • Banks, Russell K., University of Utah, Salt Lake City, Utah, United States
  • Hingorani, Sangeeta R., Seattle Children's Hospital, Seattle, Washington, United States

Group or Team Name

  • Collaborative Pediatric Critical Care Research Network
Background

Acute kidney injury (AKI) is common in critically ill children. The incidence of septic AKI and its impact on PICU survivor functional status are unknown. We used data from a multicenter cohort with sepsis to evaluate functional outcomes of children with AKI.

Methods

Using the prospective Life after Pediatric Sepsis Evaluation (LAPSE) study [R01HD073362], we evaluated the association of AKI with a composite of death or new substantive functional disability at day 28 of hospitalization or discharge as a primary outcome. We defined AKI using KIDGO criteria, comparing patients with no AKI or Stage 1 AKI to those with Stage 2 or 3 AKI (Severe AKI). New substantive disability was defined as a Functional Status Scale (FSS) score increase ≥3 points from baseline to 28 days. Wilcoxon rank-sum and likelihood ratio tests were used to compare variable associations between groups. We used multivariable logistic regression to assess the association of AKI with outcomes.

Results

176 (50.5%) of 348 patients had severe AKI; of those, 38 (21.6%) required renal replacement therapy. Patients with severe AKI had higher median PRISM III scores (excluding creatinine) (12 vs 8; p<0.001), and were treated more often with vasoactive agents (97.7 vs 91.9%; p=0.011), blood products (65.3 vs 44.8%; p<0.001), and corticosteroids (74.4 vs 61.0%; p=0.007). Twice as many patients with severe AKI died or developed new substantive disability (38.1 vs 16.3%; p<0.001). Children with severe AKI had longer PICU stays (11.7 vs 7.1 days; p<0.001), and longer duration of mechanical ventilation (11.0 vs 7.0 days; p<0.001). After adjustment for age, malignancy, and PRISM III score, severe AKI was independently associated with mortality or new substantive disability (adjusted odds ratio 2.77; 95% CI 1.63–4.81, p<0.001). Despite similar baseline FSS scores, children who survived with severe AKI had a greater sustained change in FSS scores at 28 days or hospital discharge than those without AKI (adjusted effect 1.35; 95% CI 0.27–2.43; p=0.014).

Conclusion

In critically ill children with sepsis, severe AKI is common and is independently associated with increased risk of death or new substantive disability. Survivors of sepsis with severe AKI were more likely to have persistent decreased functional status at discharge than those without severe AKI.

Funding

  • NIDDK Support