Association of early hypotension in pediatric sepsis with development of new or persistent acute kidney injury.

Acute Kidney Injury / diagnosis Child Humans Hypotension / etiology Infant Intensive Care Units, Pediatric Retrospective Studies Sepsis / complications
Acute kidney injury Child Hypotension Pediatric intensive care unit Risk factors Sepsis

Journal

Pediatric nephrology (Berlin, Germany)
ISSN: 1432-198X
Titre abrégé: Pediatr Nephrol
Pays: Germany
ID NLM: 8708728

Informations de publication

Date de publication:
02 2021
Historique:
received: 11 02 2020
accepted: 30 06 2020
revised: 17 06 2020
pubmed: 28 7 2020
medline: 24 12 2021
entrez: 26 7 2020
Statut: ppublish

Résumé

To determine how hypotension in the first 48 h of sepsis management impacts acute kidney injury (AKI) development and persistence. Retrospective study of patients > 1 month to < 20 years old with sepsis in a pediatric ICU between November 2012 and January 2015 (n = 217). All systolic blood pressure (SBP) data documented within 48 h after sepsis recognition were collected and converted to percentiles for age, sex, and height. Time below SBP percentiles and below pediatric advanced life support (PALS) targets was calculated by summing elapsed time under SBP thresholds during the first 48 h. The primary outcome was new or persistent AKI, defined as stage 2 or 3 AKI present between sepsis day 3-7 using Kidney Disease: Improving Global Outcomes creatinine definitions. Secondary outcomes included AKI-free days (days alive and free of AKI) and time to kidney recovery. Fifty of 217 sepsis patients (23%) had new or persistent AKI. Patients with AKI spent a median of 35 min under the first SBP percentile, versus 4 min in those without AKI. After adjustment for potential confounders, the odds of AKI increased by 9% with each doubling of minutes spent under this threshold (p = 0.03). Time under the first SBP percentile was also associated with fewer AKI-free days (p = 0.02). Time spent under PALS targets was not associated with AKI. The duration of severe systolic hypotension in the first 48 h of pediatric sepsis management is associated with AKI incidence and duration when defined by age, sex, and height norms, but not by PALS definitions. Graphical abstract.

Identifiants

DOI: 10.1007/s00467-020-04704-2 PMID: 32710239 PMC: PMC7856266
pubmed: 32710239
doi: 10.1007/s00467-020-04704-2
pii: 10.1007/s00467-020-04704-2
pmc: PMC7856266
mid: NIHMS1641991
doi:

Types de publication

Journal Article Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

IM

Pagination

451-461

Subventions

Organisme : NICHD NIH HHS
ID : K23 HD082368
Pays : United States
Organisme : NIDDK NIH HHS
ID : K23 DK119463
Pays : United States
Organisme : NICHD NIH HHS
ID : R43 HD096961
Pays : United States
Organisme : NIDDK NIH HHS
ID : R01 DK107566
Pays : United States
Organisme : NIDDK NIH HHS
ID : R01 DK104730
Pays : United States
Organisme : NIGMS NIH HHS
ID : K23 GM110496
Pays : United States

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Auteurs

Julie C Fitzgerald (JC)

Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA. fitzgeraldj@email.chop.edu.
Department of Anesthesiology, Perelman School of Medicine, University of Pennsylvania, 3401 Civic Center Blvd., 6th Floor Wood Building, Room 6117, Philadelphia, PA, 19104, USA. fitzgeraldj@email.chop.edu.
ORCID: 0000-0001-9936-9569

Michelle E Ross (ME)

Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.

Neal J Thomas (NJ)

Department of Pediatrics, Penn State Hershey Children's Hospital, Penn State University College of Medicine, Hershey, PA, USA.

Scott L Weiss (SL)

Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Department of Anesthesiology, Perelman School of Medicine, University of Pennsylvania, 3401 Civic Center Blvd., 6th Floor Wood Building, Room 6117, Philadelphia, PA, 19104, USA.

Fran Balamuth (F)

Department of Pediatrics, Division of Emergency Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.

Marianne Chilutti (M)

Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, PA, USA.

Robert W Grundmeier (RW)

Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, PA, USA.

Amanda Hyre Anderson (AH)

Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA.

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Classifications MeSH

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