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. 2020 Sep;21(9):e686-e695.
doi: 10.1097/PCC.0000000000002418.

Severe Acute Kidney Injury Is Associated With Increased Risk of Death and New Morbidity After Pediatric Septic Shock

Michelle C Starr  1   2 , Russell Banks  3 , Ron W Reeder  3 , Julie C Fitzgerald  4 , Murray M Pollack  5 , Kathleen L Meert  6 , Patrick S McQuillen  7 , Peter M Mourani  8 , Ranjit S Chima  9 , Samuel Sorenson  3 , James W Varni  10 , Sangeeta Hingorani  2 , Jerry J Zimmerman  11 ; Life After Pediatric Sepsis Evaluation (LAPSE) Investigators
Affiliations

Severe Acute Kidney Injury Is Associated With Increased Risk of Death and New Morbidity After Pediatric Septic Shock

Michelle C Starr et al. Pediatr Crit Care Med. 2020 Sep.

Abstract

Objectives: Acute kidney injury is common in critically ill children; however, the frequency of septic shock-associated acute kidney injury and impact on functional status are unknown. We evaluated functional outcomes of children with septic shock-associated acute kidney injury.

Design: Secondary analysis of patients with septic shock from the prospective Life after Pediatric Sepsis Evaluation study. We defined acute kidney injury using Kidney Disease Improving Global Outcomes criteria, comparing patients with absent/Stage 1 acute kidney injury to those with Stage 2/3 acute kidney injury (severe acute kidney injury). Our primary outcome was a composite of mortality or new functional morbidity at day 28 of hospitalization or discharge. We also assessed poor long-term outcome, defined as mortality or a persistent, serious deterioration in health-related quality of life at 3 months.

Setting: Twelve academic PICUs in the United States.

Patients: Critically ill children, 1 month to 18 years, with community-acquired septic shock requiring vasoactive-inotropic support.

Interventions: None.

Measurements and main results: More than 50% of patients (176/348) developed severe acute kidney injury; of those, 21.6% (38/176) required renal replacement therapy. Twice as many patients with severe acute kidney injury died or developed new substantive functional morbidity (38.6 vs 16.3%; p < 0.001). After adjustment for age, malignancy, and initial illness severity, severe acute kidney injury was independently associated with mortality or new substantive morbidity (adjusted odds ratio, 2.78; 95% CI, 1.63-4.81; p < 0.001). Children with severe acute kidney injury had poorer health-related quality of life at 3 months (adjusted effect size 2.46; 95% CI, 1.44-4.20; p = 0.002). Children with severe acute kidney injury required longer duration of mechanical ventilation (11.0 vs 7.0 d; p < 0.001) and PICU stay (11.7 vs 7.1 d; p < 0.001).

Conclusions: Among children with septic shock, severe acute kidney injury was independently associated with increased risk of death or new substantive functional morbidity. Survivors of sepsis with severe acute kidney injury were more likely to have persistent, serious health-related quality of life deterioration at 3 months.

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Conflict of interest statement

Conflicts of Interest: No performance site investigators disclose financial interests, activities, relationships, or affiliations that could be construed as real or potential conflicts of interest related to the manuscript or the related investigation. Dr. Varni holds the copyright and the trademark for the PedsQL™ and receives financial compensation from the Mapi Research Trust, which is a nonprofit research institute that charges distribution fees to for-profit companies that use the Pediatric Quality of Life Inventory™. Dr Varni provided consultation on original study design and final manuscript edits, but played no role in data acquisition or analysis.

Figures

Figure 1.
Figure 1.
LAPSE Flow Diagram
Figure 2.
Figure 2.
Distribution of Function Status Scale in subjects with and without severe acute kidney injury
See this image and copyright information in PMC

Comment in

References

    1. Ruth A, McCracken CE, Fortenberry JD, et al.: Pediatric severe sepsis: current trends and outcomes from the Pediatric Health Information Systems database. Pediatr Crit Care Med 2014; 15:828–838 - PubMed
    1. Balamuth F, Weiss SL, Neuman MI, et al.: Pediatric severe sepsis in U.S. children’s hospitals. Pediatr Crit Care Med 2014; 15:798–805 - PMC - PubMed
    1. Kaddourah A, Basu RK, Bagshaw SM, et al.: Epidemiology of Acute Kidney Injury in Critically Ill Children and Young Adults. N Engl J Med 2017; 376:11–20 - PMC - PubMed
    1. Schneider J, Khemani R, Grushkin C, et al.: Serum creatinine as stratified in the RIFLE score for acute kidney injury is associated with mortality and length of stay for children in the pediatric intensive care unit. Crit Care Med 2010; 38:933–939 - PubMed
    1. Fitzgerald JC, Basu RK, Akcan-Arikan A, et al.: Acute Kidney Injury in Pediatric Severe Sepsis: An Independent Risk Factor for Death and New Disability. Crit Care Med 2016; 44:2241–2250 - PMC - PubMed

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