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Hypertension and health outcomes in the PICU
Brett J Ehrmann1, David T Selewski, Jonathan P Troost
1Division of Pediatric Nephrology, Department of Pediatrics, C.S. Mott Children's Hospital, University of Michigan Health System, Ann Arbor, MI.
Insights
Hypertension is common in pediatric intensive care units (PICUs), affecting 25% of patients. This condition is linked to increased acute kidney injury, longer hospital stays, and higher mortality rates in children.
Area of Science:
- Pediatric critical care medicine
- Cardiovascular health in children
- Hypertension research
Background:
- Hypertension in hospitalized children is understudied, particularly in pediatric intensive care units (PICUs).
- Understanding the prevalence and impact of hypertension in the PICU is crucial for improving patient outcomes.
Purpose of the Study:
- To validate a definition for hypertension within the PICU setting.
- To assess the association between PICU hypertension and acute kidney injury (AKI).
- To evaluate the relationship between PICU hypertension and length of stay (LOS) and mortality.
Main Methods:
- A single-center retrospective study analyzed data from PICU discharges between July 2011 and February 2013.
- A validated definition of hypertension required three systolic and/or diastolic readings above the 99th percentile plus 5 mm Hg over one day.
- Multivariable regression analyses examined associations with AKI, LOS, and mortality.
Main Results:
- A validated definition identified hypertension in 25% of 1,215 analyzed pediatric patients.
- Hypertension was independently associated with a nearly threefold increased risk of AKI (OR, 2.89).
- Hypertension correlated with a significantly longer PICU length of stay (1.50 days) and a higher, though small, mortality rate (1% vs 0%).
Conclusions:
- Hypertension is a prevalent condition in the pediatric intensive care unit.
- PICU-acquired hypertension is associated with adverse clinical outcomes, including AKI, prolonged LOS, and mortality.
- Further research is warranted to confirm these findings and explore management strategies.
Objectives:
Reports of the burden of hypertension in hospitalized children are emerging, but the prevalence and significance of this condition within the PICU are not well understood. The aims of this study were to validate a definition of hypertension in the PICU and assess the associations between hypertension and acute kidney injury, PICU length of stay, and mortality.
Design And Setting:
Single-center retrospective study using a database of PICU discharges between July 2011 and February 2013.
Patients:
All children discharged from the PICU with length of stay more than 6 hours, aged 1 month through 17 years. Exclusions were traumatic brain injury, incident renal transplant, or hypotension.
Interventions:
None.
Measurements And Main Results:
Potential definitions of hypertension utilizing combinations of standardized cutoff percentiles, durations, initiation or dose escalation of antihypertensives, and/or billing diagnosis codes for hypertension were compared using receiver operator characteristic curves against a manual medical record review. Multivariable logistic and linear regression analyses were conducted using the selected definition of hypertension to assess its independent association with acute kidney injury and PICU length of stay, respectively. A definition requiring three systolic and/or diastolic readings above standardized 99th percentiles plus 5 mm Hg over 1 day was selected (area under the curve, 0.91; sensitivity, 94%; specificity, 87%). Among the 1,215 patients in this analysis, the prevalence of hypertension was 25%. Hypertension was independently associated with acute kidney injury (odds ratio, 2.89; 95% CI, 1.64-5.09; p < 0.01) and increased PICU length of stay (1.50 d; 95% CI, 0.94-2.05; p < 0.01) in multivariable analyses. Deaths were rare-0 in the normotension group and 3 (1%) in the hypertension group-but were statistically different (p = 0.02).
Conclusions:
Hypertension is common in the PICU and is associated with worse clinical outcomes. Future studies are needed to confirm these results.
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