Abstract: PO0259
Disseminated Intravascular Coagulation Is Associated with AKI in Pediatric Severe Sepsis
Session Information
- AKI: Clinical, Outcomes, and Trials
November 04, 2021 | Location: On-Demand, Virtual Only
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
Authors
- Akcan Arikan, Ayse, Baylor College of Medicine, Houston, Texas, United States
- Smaglick, Michael P., Baylor College of Medicine, Houston, Texas, United States
- Vijayan, Vinod, Baylor College of Medicine, Houston, Texas, United States
- Kennedy, Curtis E., Baylor College of Medicine, Houston, Texas, United States
- Moffett, Brady S., Texas Children's Hospital, Houston, Texas, United States
- Srivaths, Poyyapakkam, Baylor College of Medicine, Houston, Texas, United States
- Nguyen, Trung C., Baylor College of Medicine, Houston, Texas, United States
Background
Exact mechanism of pediatric septic acute kidney injury (AKI) remains unknown. Coagulation pertubations like disseminated intravascular coagulation (DIC) are frequent in sepsis and associated with organ dysfunction. The link between DIC and septic AKI has not been adequately explored in pediatric patients.
Methods
Single center cohort study of pediatric patients with severe sepsis Jan 2017-Apr2018. Primary outcome was AKI (per Kidney Disease Improving Global Outcomes creatinine criteria), primary exposure was DIC (per International Society of Thrombosis and Haemostasis criteria).
Results
287 patients were enrolled, median age 7.3 (IQR 1.6-14.5) years; 58% had AKI, 34% had DIC. Pediatric risk of mortality score was 8 (IQR 4-13), 57% were mechanically ventilated and 67% were on vasopressors. DIC prevalence was 52% in AKI pts vs 19% in no AKI pts (p<0.001). DIC score was higher in AKI (4.27 (IQR3.85- 4.67) vs 2.25 (IQR1.92- 2.58) in no AKI (p<0.001)). In adjusted analysis controlling for severity of illness, mechanical ventilation, and vasopressor use, DIC presence (aOR 2.6 (95%CI 1.45-4.67)) and DIC score (aOR 1.33 (95% CI 1.17-1.51)) were both independently associated with AKI.
Conclusion
DIC is very common in pediatric septic AKI. Severity and presence of DIC are both independently associated with septic AKI. Mechanistic contribution of coagulation perturbations to septic AKI and identification of potential modifiable factors require further study.