Abstract: FR-PO021
The Association of AKI with Hospital Readmission or Death After Pediatric Cardiac Surgery
Session Information
- AKI: Epidemiology, Risk Factors, Prevention - II
November 08, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 101 AKI: Epidemiology, Risk Factors, and Prevention
Authors
- Nunes, Sophia, The Hospital for Sick Children, Toronto, Ontario, Canada
- Greenberg, Jason Henry, Yale University, Woodbridge, Connecticut, United States
- Parikh, Chirag R., Johns Hopkins University, Newton, Massachusetts, United States
- Brown, Jeremiah R., The Dartmouth Institute, Lebanon, New Hampshire, United States
- Thiessen Philbrook, Heather, Johns Hopkins University, Newton, Massachusetts, United States
- Devarajan, Prasad, Cincinnati Children's Hospital, Cincinnati, Ohio, United States
- Palijan, Ana, McGill University Health Centre, Montreal, Quebec, Canada
- Zappitelli, Michael, Toronto Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
Group or Team Name
- TRIBE-AKI
Background
AKI in children undergoing cardiac surgery (CS) is strongly associated with increased hospital morbidity, however post-discharge AKI outcomes are less studied. Hypotheses: In children undergoing CS with cardiopulmonary bypass (CPB), a) AKI is associated with increased risk for readmission or death within 30 days and 1 year of CS discharge, and b) the association of AKI with outcomes is modified by surgical severity and cyanotic heart disease.
Methods
Prospective 3-centre cohort study of children surviving to hospital discharge after CS with CPB. Main exposure: AKI during index CS admission defined by KDIGO. Composite outcome: readmission to hospital or death at a) 30 days and b) 1 year from CS hospital discharge. Other data: detailed pre/post-op CS patient/treatment variables (including Risk Adjustment for Congenital Heart Surgery-1 [RACHS-1] score; presence of cyanotic heart disease). Association of AKI with time to outcomes was determined using multivariable Cox-proportional hazards analysis (adjusted for age, RACHS-1 score ≥3, CPB time>120 mins). RACHS-1 score≥3 and cyanotic heart disease were evaluated as effect modifiers.
Results
Of the 360 participants included (mean age 4.0±4.6 years, 155 [43%] AKI, 47 [13%] ≥Stage 2 AKI), 4 (1.1%) and 6 (1.7%) died and 30 (8.3%) and 99 (27.5%) were readmitted within 30 days and 1 year post-discharge, respectively. Figure illustrates a graded increase in the risk of the composite outcome with increasing AKI stage. AKI and ≥Stage 2 AKI were associated with time to outcome within 30 days (adjusted HR 2.14 [95%CI 1.04-4.41] and 2.39 [95% CI 1.08-5.27], respectively) but not within 1 year of CS discharge. RACHS-1 and cyanotic heart disease did not modify these relationships (interaction p value>0.1).
Conclusion
Children with AKI post-CS were more likely to be readmitted or die within 30 days of CS discharge, compared to children without AKI. Future research should evaluate measures to reduce short-term morbidity and mortality risk in children who develop AKI after CS.
Funding
- NIDDK Support