Abstract: PO0258
AKI and Hospital-Acquired Sepsis in Critically Ill Children: A Retrospective Single-Center Study
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
- Formeck, Cassandra Lynn, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
- Feldman, Robert, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
- Althouse, Andrew D., University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
- Kellum, John A., University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
Background
Acute kidney injury (AKI) is common among critically ill children and is associated with an increased risk for de novo infection, however little is known about the temporal relationship between AKI and risk for subsequent infection. The objective of this study was to describe the risk of developing hospital-acquired sepsis over time following AKI onset.
Methods
We conducted a single-center retrospective cohort study of critically ill children admitted to the pediatric and cardiac ICUs at a tertiary pediatric care center in the United States. The cohort included children, ages birth to 18 years, without a diagnosis of chronic kidney disease, primary immunodeficiency, or sepsis within the first 48 hours of hospital admission. The relationship between the primary exposure (AKI) and primary outcome (development of hospital-acquired sepsis) was assessed using Cox proportional-hazards models using AKI as a time-varying covariate.
Results
Among the 5695 children included in the study, hospital-acquired sepsis was more common in the 1153 children that developed AKI (n=117, 10.7%) than in the 4542 children that did not develop AKI (n=210, 4.6%). Over a median follow-up of 3.1 days, the development of AKI was associated with an increased risk for development of hospital-acquired sepsis with an adjusted HR of 1.41 (95% CI 1.11-1.80, p=0.005). The median time from AKI onset to sepsis was 2.6 days (IQR 1.5 – 4.7). Among the 117 children who developed hospital-acquired sepsis following AKI (from 48 hours after hospital admission through hospital discharge or 30 days), 80.3% of children developed sepsis within 7 day and 96.6% within 14 days of AKI onset.
Conclusion
AKI is an independent risk factor for de novo infection. Children with AKI are at highest risk for developing hospital-acquired sepsis within 14 days following AKI onset.