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Pediatric severe sepsis: epidemiology and risk factors associated with acute kidney injury
Haibo Li1, Ying Zhang2, Hongyan Zhu1
1Department of Anesthesiology, Affiliated Chifeng Clinical Medical College of Inner Mongolia Medical University, Chifeng Municipal Hospital, Chifeng, China.
Insights
Pediatric severe sepsis with acute kidney injury (AKI) saw increased incidence but decreased mortality from 2010-2019. Early identification of AKI risk factors in children is vital for improving outcomes.
Area of Science:
- Pediatric Critical Care Medicine
- Nephrology
- Epidemiology
Background:
- Pediatric severe sepsis (PSS) is a major cause of child mortality.
- Acute kidney injury (AKI) significantly impacts PSS severity and prognosis.
- Limited data exists on AKI risk factors and outcomes in pediatric sepsis.
Purpose of the Study:
- Analyze temporal trends in AKI incidence and outcomes in PSS patients (2010-2019).
- Identify risk factors associated with AKI in pediatric sepsis.
- Assess AKI's impact on in-hospital mortality and healthcare resource utilization.
Main Methods:
- Retrospective analysis of the US National Inpatient Sample (NIS) database (2010-2019).
- Included children (0-18 years) diagnosed with severe sepsis.
- Compared outcomes (mortality, length of stay, costs) between AKI and non-AKI groups; used multivariate regression for risk factors.
Main Results:
- AKI incidence in PSS patients rose from 2.7% (2010) to 8.0% (2019).
- In-hospital mortality for PSS with AKI decreased from 32.40% to 17.90% during the study period.
- AKI was more common in patients with comorbidities and linked to higher infection rates.
Conclusions:
- Increased AKI recognition and critical care advancements likely explain rising incidence with falling mortality.
- AKI remains a strong indicator of PSS severity, increasing mortality risk sevenfold.
- Early identification of children at risk for AKI is essential for improved survival.
Background:
Pediatric severe sepsis (PSS) is one of the leading causes of morbidity and mortality in children, incurring substantial social costs. Acute kidney injury (AKI) plays a critical role in determining PSS severity and prognosis. However, existing literature provides limited data regarding the risk factors associated with AKI in pediatric sepsis patients and the impact of AKI on hospital outcomes for these patients. This study aimed to analyze the temporal trends in incidence and outcomes of AKI among hospitalized PSS patients from 2010 to 2019, and identify associated risk factors; and assess the impact of AKI on in-hospital mortality and healthcare resource utilization.
Methods:
This study utilized the nationally representative National Inpatient Sample (NIS) database of the United States to conduct a retrospective analysis. All children aged 0 (infants) to 18 years who were diagnosed with severe sepsis between 2010 and 2019 were included. Patients were grouped by AKI status, and in-hospital mortality and medical resource utilization (length of stay and inflation-adjusted costs) were compared. Multivariate regression identified AKI risk factors.
Results:
The incidence rate of AKI among hospitalized PSS patients increased from 2.7% in 2010 to 8.0% in 2019. However, in-hospital mortality declined from 32.40% to 17.90% over the same period. The incidence of AKI was significantly higher in patients with comorbidities. Studies have shown that hospitalizations associated with AKI have a higher likelihood of involving infection sites and a variety of pathogenic flora.
Conclusion:
While the incidence of AKI increased from 2010 to 2019, associated mortality decreased. This likely reflects advancements in critical care that are improving survival, even as more cases are recognized. AKI, affecting 5% of PSS patients, remained a potent marker of severity, was associated with a sevenfold increased risk of mortality and driven by identifiable risk factors like specific comorbidities and infections. Enhanced early identification of at-risk children is crucial to further improve outcomes.
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