Acute Kidney Injury in Pediatric Severe Sepsis: An Independent Risk Factor for Death and New Disability

Sepsis PRevalence, OUtcomes, and Therapies Study Investigators and Pediatric Acute Lung Injury and Sepsis Investigators Network

Research output: Contribution to journalArticle

20 Citations (Scopus)

Abstract

Objectives: The prevalence of septic acute kidney injury and impact on functional status of PICU survivors are unknown. We used data from an international prospective severe sepsis study to elucidate functional outcomes of children suffering septic acute kidney injury. Design: Secondary analysis of patients in the Sepsis PRevalence, OUtcomes, and Therapies point prevalence study: acute kidney injury was defined on the study day using Kidney Disease Improving Global Outcomes definitions. Patients with no acute kidney injury or stage 1 acute kidney injury ("no/mild acute kidney injury") were compared with those with stage 2 or 3 acute kidney injury ("severe acute kidney injury"). The primary outcome was a composite of death or new moderate disability at discharge defined as a Pediatric Overall Performance Category score of 3 or higher and increased by 1 from baseline. Setting: One hundred twenty-eight PICUs in 26 countries. Patients: Children with severe sepsis in the Sepsis PRevalence, OUtcomes, and Therapies study. Interventions: None. Measurements and Main Results: One hundred two (21%) of 493 patients had severe acute kidney injury. More than twice as many patients with severe acute kidney injury died or developed new moderate disability compared with those with no/mild acute kidney injury (64% vs 30%; p < 0.001). Severe acute kidney injury was independently associated with death or new moderate disability (adjusted odds ratio, 2.5; 95% CI, 1.5-4.2; p = 0.001) after adjustment for age, region, baseline disability, malignancy, invasive mechanical ventilation, albumin administration, and the pediatric logistic organ dysfunction score. Conclusions: In a multinational cohort of critically ill children with severe sepsis and high mortality rates, septic acute kidney injury is independently associated with further increased death or new disability.

Original languageEnglish (US)
Pages (from-to)2241-2250
Number of pages10
JournalCritical care medicine
Volume44
Issue number12
DOIs
StatePublished - Dec 1 2016

Fingerprint

Acute Kidney Injury
Sepsis
Pediatrics
Organ Dysfunction Scores
Kidney Diseases
Artificial Respiration
Critical Illness
Survivors
Albumins
Cross-Sectional Studies
Odds Ratio
Outcome Assessment (Health Care)

Keywords

  • acute kidney injury
  • critical care outcomes
  • epidemiology
  • pediatric intensive care units
  • renal replacement therapy
  • sepsis

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Sepsis PRevalence, OUtcomes, and Therapies Study Investigators and Pediatric Acute Lung Injury and Sepsis Investigators Network (2016). Acute Kidney Injury in Pediatric Severe Sepsis: An Independent Risk Factor for Death and New Disability. Critical care medicine, 44(12), 2241-2250. https://doi.org/10.1097/CCM.0000000000002007

Acute Kidney Injury in Pediatric Severe Sepsis : An Independent Risk Factor for Death and New Disability. / Sepsis PRevalence, OUtcomes, and Therapies Study Investigators and Pediatric Acute Lung Injury and Sepsis Investigators Network.

In: Critical care medicine, Vol. 44, No. 12, 01.12.2016, p. 2241-2250.

Research output: Contribution to journalArticle

Sepsis PRevalence, OUtcomes, and Therapies Study Investigators and Pediatric Acute Lung Injury and Sepsis Investigators Network 2016, 'Acute Kidney Injury in Pediatric Severe Sepsis: An Independent Risk Factor for Death and New Disability', Critical care medicine, vol. 44, no. 12, pp. 2241-2250. https://doi.org/10.1097/CCM.0000000000002007
Sepsis PRevalence, OUtcomes, and Therapies Study Investigators and Pediatric Acute Lung Injury and Sepsis Investigators Network. Acute Kidney Injury in Pediatric Severe Sepsis: An Independent Risk Factor for Death and New Disability. Critical care medicine. 2016 Dec 1;44(12):2241-2250. https://doi.org/10.1097/CCM.0000000000002007
Sepsis PRevalence, OUtcomes, and Therapies Study Investigators and Pediatric Acute Lung Injury and Sepsis Investigators Network. / Acute Kidney Injury in Pediatric Severe Sepsis : An Independent Risk Factor for Death and New Disability. In: Critical care medicine. 2016 ; Vol. 44, No. 12. pp. 2241-2250.
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T1 - Acute Kidney Injury in Pediatric Severe Sepsis

T2 - An Independent Risk Factor for Death and New Disability

AU - Sepsis PRevalence, OUtcomes, and Therapies Study Investigators and Pediatric Acute Lung Injury and Sepsis Investigators Network

AU - Fitzgerald, Julie C.

AU - Basu, Rajit K.

AU - Akcan-Arikan, Ayse

AU - Izquierdo, Ledys M.

AU - Piñeres Olave, Byron E.

AU - Hassinger, Amanda B.

AU - Szczepanska, Maria

AU - Deep, Akash

AU - Williams, Duane

AU - Sapru, Anil

AU - Roy, Jason A.

AU - Nadkarni, Vinay M.

AU - Thomas, Neal J.

AU - Weiss, Scott L.

AU - Furth, Susan

AU - Fontela, P.

AU - Tucci, M.

AU - Dumistrascu, M.

AU - Skippen, P.

AU - Krahn, G.

AU - Bezares, E.

AU - Puig, G.

AU - Puig-Ramos, A.

AU - Garcia, R.

AU - Villar, M.

AU - Bigham, M.

AU - Polanski, T.

AU - Latifi, S.

AU - Giebne, D.

AU - Anthony, H.

AU - Hume, J.

AU - Galster, A.

AU - Linnerud, L.

AU - Sanders, R.

AU - Hefley, G.

AU - Madden, K.

AU - Thompson, A.

AU - Shein, S.

AU - Gertz, S.

AU - Han, Y.

AU - Hughes-Schalk, A.

AU - Chandler, H.

AU - Orioles, A.

AU - Zielinski, E.

AU - Doucette, A.

AU - Zebuhr, C.

AU - Wilson, T.

AU - Dimitriades, C.

AU - Ascani, J.

AU - Kirby, Aileen

PY - 2016/12/1

Y1 - 2016/12/1

N2 - Objectives: The prevalence of septic acute kidney injury and impact on functional status of PICU survivors are unknown. We used data from an international prospective severe sepsis study to elucidate functional outcomes of children suffering septic acute kidney injury. Design: Secondary analysis of patients in the Sepsis PRevalence, OUtcomes, and Therapies point prevalence study: acute kidney injury was defined on the study day using Kidney Disease Improving Global Outcomes definitions. Patients with no acute kidney injury or stage 1 acute kidney injury ("no/mild acute kidney injury") were compared with those with stage 2 or 3 acute kidney injury ("severe acute kidney injury"). The primary outcome was a composite of death or new moderate disability at discharge defined as a Pediatric Overall Performance Category score of 3 or higher and increased by 1 from baseline. Setting: One hundred twenty-eight PICUs in 26 countries. Patients: Children with severe sepsis in the Sepsis PRevalence, OUtcomes, and Therapies study. Interventions: None. Measurements and Main Results: One hundred two (21%) of 493 patients had severe acute kidney injury. More than twice as many patients with severe acute kidney injury died or developed new moderate disability compared with those with no/mild acute kidney injury (64% vs 30%; p < 0.001). Severe acute kidney injury was independently associated with death or new moderate disability (adjusted odds ratio, 2.5; 95% CI, 1.5-4.2; p = 0.001) after adjustment for age, region, baseline disability, malignancy, invasive mechanical ventilation, albumin administration, and the pediatric logistic organ dysfunction score. Conclusions: In a multinational cohort of critically ill children with severe sepsis and high mortality rates, septic acute kidney injury is independently associated with further increased death or new disability.

AB - Objectives: The prevalence of septic acute kidney injury and impact on functional status of PICU survivors are unknown. We used data from an international prospective severe sepsis study to elucidate functional outcomes of children suffering septic acute kidney injury. Design: Secondary analysis of patients in the Sepsis PRevalence, OUtcomes, and Therapies point prevalence study: acute kidney injury was defined on the study day using Kidney Disease Improving Global Outcomes definitions. Patients with no acute kidney injury or stage 1 acute kidney injury ("no/mild acute kidney injury") were compared with those with stage 2 or 3 acute kidney injury ("severe acute kidney injury"). The primary outcome was a composite of death or new moderate disability at discharge defined as a Pediatric Overall Performance Category score of 3 or higher and increased by 1 from baseline. Setting: One hundred twenty-eight PICUs in 26 countries. Patients: Children with severe sepsis in the Sepsis PRevalence, OUtcomes, and Therapies study. Interventions: None. Measurements and Main Results: One hundred two (21%) of 493 patients had severe acute kidney injury. More than twice as many patients with severe acute kidney injury died or developed new moderate disability compared with those with no/mild acute kidney injury (64% vs 30%; p < 0.001). Severe acute kidney injury was independently associated with death or new moderate disability (adjusted odds ratio, 2.5; 95% CI, 1.5-4.2; p = 0.001) after adjustment for age, region, baseline disability, malignancy, invasive mechanical ventilation, albumin administration, and the pediatric logistic organ dysfunction score. Conclusions: In a multinational cohort of critically ill children with severe sepsis and high mortality rates, septic acute kidney injury is independently associated with further increased death or new disability.

KW - acute kidney injury

KW - critical care outcomes

KW - epidemiology

KW - pediatric intensive care units

KW - renal replacement therapy

KW - sepsis

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