Abstract: SA-PO152
AKI: A Risk Factor for Sepsis in Critically Ill Children
Session Information
- AKI: Epidemiology, Risk Factors, Prevention - III
November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
Authors
- Formeck, Cassandra Lynn, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, United States
- Joyce, Emily Lauren, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, United States
- Kellum, John A., University of Pittsburgh, Pittsburgh, Pennsylvania, United States
Background
Acute kidney injury (AKI) affects up to 56% of pediatric patients admitted to pediatric intensive care units (ICUs) worldwide, and is now recognized as a systemic disease with numerous short and long-term complications that independently increase morbidity and mortality. Evolving evidence suggests that AKI alters innate immune function, which may place patients at increased risk for subsequent infection. We hypothesized that that critically ill children with AKI will be at higher risk of developing hospital-acquired infections compared to critically ill children without AKI. Our objective was to compare the rates of sepsis manifesting in critically ill children with and without AKI at ICU admission, while controlling for severity of illness.
Methods
Using a pediatric ICU database of 8,733 admissions, we included patients who had sufficient information to categorize AKI status, and excluded patients if they had sepsis prior to or within the first 48 hours of ICU admission. Using logistic regression analysis we evaluated the association between exposure to stage 2 or 3 AKI during the first 48 hours of ICU admission, on the development of sepsis during the 7 days following the 48 hour exposure window (days 3-9), adjusting for severity of illness and other known risk factors for sepsis. The covariates included in the final model were age, race, sex, Pediatric Index of Mortality 2 score, vasopressor use, mechanical ventilation, elective admission to the ICU, recovery from surgery and a history of heart failure, liver failure, chronic kidney disease or malignancy.
Results
A total of 5,590 patient admissions (male 58%, mean age 6.9 years) were included in the analysis. 5.2% of patients had stage 2 or 3 AKI during the first 48 hours of admission and 6.0% of patients developed sepsis on days 3 through 9 of ICU admission. The incidence of sepsis was 16.9% in patients with stage 2 or 3 AKI, as compared to 5.4% in patients without AKI. In the adjusted analysis, patients with AKI were more likely to develop sepsis (OR 2.04, P <0.001).
Conclusion
Stage 2 or 3 AKI is a significant risk factor for development of sepsis in critically ill children.
Funding
- NIDDK Support