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Risk Factors for Sepsis-Associated Acute Kidney Injury in the PICU: A Retrospective Cohort Study

Emily K Ninmer1, Jennifer R Charlton2, Michael C Spaeder3

  • 1University of Virginia School of Medicine, Charlottesville, VA.

Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies
|April 18, 2022
PubMed

Insights

Severe acute kidney injury (AKI) in pediatric sepsis patients is linked to hemodynamic support needs and fluid overload. Identifying these risk factors is crucial for better outcomes in the pediatric intensive care unit (PICU).

Area of Science:

  • Pediatric Critical Care Medicine
  • Nephrology
  • Pediatric Sepsis Research

Background:

  • Acute kidney injury (AKI) significantly increases morbidity and mortality in children, especially when associated with severe sepsis.
  • Risk factors for sepsis-associated AKI in the pediatric intensive care unit (PICU) are not well understood.
  • Early identification of severe AKI risk is critical for timely intervention in pediatric sepsis.

Purpose of the Study:

  • To identify risk factors for AKI developing or persisting after 72 hours in pediatric patients with severe sepsis.
  • To investigate the association between hemodynamic support and fluid overload with severe AKI in this population.

Main Methods:

  • Retrospective cohort study of 124 pediatric patients with severe sepsis admitted to a combined cardiac and medical/surgical PICU.
  • AKI was defined using Kidney Disease: Improving Global Outcomes (KDIGO) criteria.
  • Severe AKI was defined as KDIGO stage 2 or 3 between days 3-7 post-sepsis recognition.

Main Results:

  • 25 patients (20%) experienced severe AKI.
  • Maximum vasoactive-inotropic score (VIS) within 48 hours and fluid overload were independently associated with severe AKI.
  • Severe AKI was linked to increased in-hospital mortality.

Conclusions:

  • The degree of hemodynamic support (VIS) and fluid overload are key indicators for severe AKI risk in pediatric sepsis.
  • These factors may help identify high-risk patients for proactive management strategies.
  • Further research can refine predictive models for sepsis-associated AKI in children.
Abstract

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