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. 2021 Jan 1;22(1):e58-e66.
doi: 10.1097/PCC.0000000000002541.

Association of Acute Kidney Injury With Subsequent Sepsis in Critically Ill Children

Cassandra L Formeck  1   2   3   4   5 , Emily L Joyce  2   4 , Dana Y Fuhrman  1   2   3   5 , John A Kellum  2   3   5
Affiliations

Association of Acute Kidney Injury With Subsequent Sepsis in Critically Ill Children

Cassandra L Formeck et al. Pediatr Crit Care Med. .

Abstract

Objectives: Acute kidney injury is a major cause of morbidity and mortality in critically ill children. A growing body of evidence has shown that acute kidney injury affects immune function, yet little is known about the association between acute kidney injury and subsequent infection in pediatric patients. Our objective was to examine the association of non-septic acute kidney injury with the development of subsequent sepsis in critically ill children.

Design: A single-center retrospective cohort study.

Setting: The pediatric and cardiac ICUs at a tertiary pediatric care center.

Patients: All patients 0-18 years old without a history of chronic kidney disease, who did not have sepsis prior to or within the initial 48 hours of ICU admission.

Interventions: None.

Measurements and main results: We analyzed data for 5,538 children (median age, 5.3 yr; 58.2% male), and identified 255 (4.6%) with stage 2 or 3 acute kidney injury. Suspected sepsis occurred in 46 children (18%) with stage 2 or 3 acute kidney injury compared to 286 children (5.4%) with stage 1 or no acute kidney injury. On adjusted analysis, children with stage 2 or 3 acute kidney injury had 2.05 times greater odds of developing sepsis compared to those with stage 1 or no acute kidney injury (95% CI, 1.39-3.03; p < 0.001). Looking at acute kidney injury severity, children with stage 2 and 3 acute kidney injury had a 1.79-fold (95% CI, 1.15-2.79; p = 0.01) and 3.24-fold (95% CI, 1.55-6.80; p = 0.002) increased odds of developing suspected sepsis, respectively.

Conclusions: Acute kidney injury is associated with an increased risk for subsequent infection in critically ill children. These results further support the concept of acute kidney injury as a clinically relevant immunocompromised state.

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Conflict of interest statement

Dr. Formeck’s institution received funding from T32 DK091202 and she received support for article research from the National Institutes of Health. The remaining authors have disclosed that they do not have any potential conflicts of interest.

Figures

Figure 1.
Figure 1.. Flow Diagram of Study Cohort with Exclusions
Abbreviations: AKI, acute kidney injury; CKD, chronic kidney disease; ICU, intensive care unit
See this image and copyright information in PMC

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