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Severe Acute Kidney Injury Is Associated With Increased Risk of Death and New Morbidity After Pediatric Septic Shock.
Pediatr Crit Care Med. 2020 09; 21(9):e686-e695.PC

Abstract

OBJECTIVES

Acute kidney injury is common in critically ill children; however, the frequency of septic shock-associated acute kidney injury and impact on functional status are unknown. We evaluated functional outcomes of children with septic shock-associated acute kidney injury.

DESIGN

Secondary analysis of patients with septic shock from the prospective Life after Pediatric Sepsis Evaluation study. We defined acute kidney injury using Kidney Disease Improving Global Outcomes criteria, comparing patients with absent/Stage 1 acute kidney injury to those with Stage 2/3 acute kidney injury (severe acute kidney injury). Our primary outcome was a composite of mortality or new functional morbidity at day 28 of hospitalization or discharge. We also assessed poor long-term outcome, defined as mortality or a persistent, serious deterioration in health-related quality of life at 3 months.

SETTING

Twelve academic PICUs in the United States.

PATIENTS

Critically ill children, 1 month to 18 years, with community-acquired septic shock requiring vasoactive-inotropic support.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

More than 50% of patients (176/348) developed severe acute kidney injury; of those, 21.6% (38/176) required renal replacement therapy. Twice as many patients with severe acute kidney injury died or developed new substantive functional morbidity (38.6 vs 16.3%; p < 0.001). After adjustment for age, malignancy, and initial illness severity, severe acute kidney injury was independently associated with mortality or new substantive morbidity (adjusted odds ratio, 2.78; 95% CI, 1.63-4.81; p < 0.001). Children with severe acute kidney injury had poorer health-related quality of life at 3 months (adjusted effect size 2.46; 95% CI, 1.44-4.20; p = 0.002). Children with severe acute kidney injury required longer duration of mechanical ventilation (11.0 vs 7.0 d; p < 0.001) and PICU stay (11.7 vs 7.1 d; p < 0.001).

CONCLUSIONS

Among children with septic shock, severe acute kidney injury was independently associated with increased risk of death or new substantive functional morbidity. Survivors of sepsis with severe acute kidney injury were more likely to have persistent, serious health-related quality of life deterioration at 3 months.

Authors+Show Affiliations

Division of Nephrology, Department of Pediatrics, Indiana University, Indianapolis, IN. Division of Nephrology, Department of Pediatrics, Seattle Children's Hospital and University of Washington, Seattle, WA.Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Utah, Salt Lake City, UT.Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Utah, Salt Lake City, UT.Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA.Division of Pediatric Critical Care Medicine, Department of Pediatrics, Children's National Medical Center, Washington, DC.Division of Pediatric Critical Care Medicine, Department of Pediatrics, Children's Hospital of Michigan, Detroit, MI.Division of Pediatric Critical Care Medicine, Department of Pediatrics, Benioff Children's Hospital, University of California, San Francisco, San Francisco, CA.Division of Pediatric Critical Care Medicine, Department of Pediatrics, Children's Hospital of Colorado, Denver, CO.Division of Critical Care Medicine, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Utah, Salt Lake City, UT.Department of Landscape Architecture and Urban Planning, Texas A&M University, College Station, TX.Division of Nephrology, Department of Pediatrics, Seattle Children's Hospital and University of Washington, Seattle, WA.Division of Pediatric Critical Care Medicine, Department of Pediatrics, Seattle Children's Hospital, Seattle Children's Research Institute, University of Washington School of Medicine, Seattle, WA.No affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

32569242

Citation

Starr, Michelle C., et al. "Severe Acute Kidney Injury Is Associated With Increased Risk of Death and New Morbidity After Pediatric Septic Shock." Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies, vol. 21, no. 9, 2020, pp. e686-e695.
Starr MC, Banks R, Reeder RW, et al. Severe Acute Kidney Injury Is Associated With Increased Risk of Death and New Morbidity After Pediatric Septic Shock. Pediatr Crit Care Med. 2020;21(9):e686-e695.
Starr, M. C., Banks, R., Reeder, R. W., Fitzgerald, J. C., Pollack, M. M., Meert, K. L., McQuillen, P. S., Mourani, P. M., Chima, R. S., Sorenson, S., Varni, J. W., Hingorani, S., & Zimmerman, J. J. (2020). Severe Acute Kidney Injury Is Associated With Increased Risk of Death and New Morbidity After Pediatric Septic Shock. Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies, 21(9), e686-e695. https://doi.org/10.1097/PCC.0000000000002418
Starr MC, et al. Severe Acute Kidney Injury Is Associated With Increased Risk of Death and New Morbidity After Pediatric Septic Shock. Pediatr Crit Care Med. 2020;21(9):e686-e695. PubMed PMID: 32569242.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Severe Acute Kidney Injury Is Associated With Increased Risk of Death and New Morbidity After Pediatric Septic Shock. AU - Starr,Michelle C, AU - Banks,Russell, AU - Reeder,Ron W, AU - Fitzgerald,Julie C, AU - Pollack,Murray M, AU - Meert,Kathleen L, AU - McQuillen,Patrick S, AU - Mourani,Peter M, AU - Chima,Ranjit S, AU - Sorenson,Samuel, AU - Varni,James W, AU - Hingorani,Sangeeta, AU - Zimmerman,Jerry J, AU - ,, PY - 2021/09/01/pmc-release PY - 2020/6/23/pubmed PY - 2021/1/7/medline PY - 2020/6/23/entrez SP - e686 EP - e695 JF - Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies JO - Pediatr Crit Care Med VL - 21 IS - 9 N2 - OBJECTIVES: Acute kidney injury is common in critically ill children; however, the frequency of septic shock-associated acute kidney injury and impact on functional status are unknown. We evaluated functional outcomes of children with septic shock-associated acute kidney injury. DESIGN: Secondary analysis of patients with septic shock from the prospective Life after Pediatric Sepsis Evaluation study. We defined acute kidney injury using Kidney Disease Improving Global Outcomes criteria, comparing patients with absent/Stage 1 acute kidney injury to those with Stage 2/3 acute kidney injury (severe acute kidney injury). Our primary outcome was a composite of mortality or new functional morbidity at day 28 of hospitalization or discharge. We also assessed poor long-term outcome, defined as mortality or a persistent, serious deterioration in health-related quality of life at 3 months. SETTING: Twelve academic PICUs in the United States. PATIENTS: Critically ill children, 1 month to 18 years, with community-acquired septic shock requiring vasoactive-inotropic support. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: More than 50% of patients (176/348) developed severe acute kidney injury; of those, 21.6% (38/176) required renal replacement therapy. Twice as many patients with severe acute kidney injury died or developed new substantive functional morbidity (38.6 vs 16.3%; p < 0.001). After adjustment for age, malignancy, and initial illness severity, severe acute kidney injury was independently associated with mortality or new substantive morbidity (adjusted odds ratio, 2.78; 95% CI, 1.63-4.81; p < 0.001). Children with severe acute kidney injury had poorer health-related quality of life at 3 months (adjusted effect size 2.46; 95% CI, 1.44-4.20; p = 0.002). Children with severe acute kidney injury required longer duration of mechanical ventilation (11.0 vs 7.0 d; p < 0.001) and PICU stay (11.7 vs 7.1 d; p < 0.001). CONCLUSIONS: Among children with septic shock, severe acute kidney injury was independently associated with increased risk of death or new substantive functional morbidity. Survivors of sepsis with severe acute kidney injury were more likely to have persistent, serious health-related quality of life deterioration at 3 months. SN - 1529-7535 UR - https://www.unboundmedicine.com/medline/citation/32569242/Severe_Acute_Kidney_Injury_Is_Associated_With_Increased_Risk_of_Death_and_New_Morbidity_After_Pediatric_Septic_Shock_ L2 - https://doi.org/10.1097/PCC.0000000000002418 DB - PRIME DP - Unbound Medicine ER -