Impact of the development of acute kidney injury on patients admitted to the pediatric intensive care unit

Ferreira, Marina Catuta de Rezende; Lima, Emerson Quintino

doi:10.1016/j.jped.2019.05.003

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Original articles • J. Pediatr. (Rio J.) 96 (5) • Sep-Oct 2020 • https://doi.org/10.1016/j.jped.2019.05.003 copy

Impact of the development of acute kidney injury on patients admitted to the pediatric intensive care unit^☆ ☆ Study conducted at Hospital de Base, Faculdade de Medicina de São José do Rio Preto (Famerp), São José do Rio Preto, SP, Brazil. , ^☆☆ ☆☆ Please cite this article as: Ferreira MC, Lima EQ. Impact of the development of acute kidney injury on patients admitted to the pediatric intensive care unit. J Pediatr (Rio J). 2020;96:576-81.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

To identify the risk factors for the development of acute kidney injury and for short and long-term mortality of patients with acute kidney injury after admission to the Pediatric Intensive Care Unit.

Materials and methods:

Retrospective analysis of patients admitted to the Pediatric Intensive Care Unit from January 2004 to December 2008. Acute kidney injury was defined by the KDIGO criterion. Risk factors for acute kidney injury, in-hospital, and long-term mortality were obtained through multivariate logistic regression analysis. Long-term mortality (up to 2011) was obtained by searching the institution's database and by telephone contact with patients' family members.

Results:

A total of 434 patients were evaluated and the incidence of acute kidney injury was 64%. Most acute kidney injury episodes (78%) occurred within the first 24hours after admission to the Pediatric Intensive Care Unit. The risk factors for the development of acute kidney injury were: low volume of diuresis, younger age, mechanical ventilation, vasoactive drugs, diuretics, and amphotericin. Lower weight, positive fluid balance, acute kidney injury, dopamine use and mechanical ventilation were independent risk factors for in-hospital mortality. Long-term mortality was 17.8%. Systolic blood pressure, PRISM score, low volume of diuresis, and mechanical ventilation were independent risk factors associated with long-term mortality after admission to the Pediatric Intensive Care Unit.

Conclusion:

Acute kidney injury was a frequent, early event, and was associated with in-hospital mortality and long-term mortality after admission to the Pediatric Intensive Care Unit.

KEYWORDS
Acute kidney injury; Pediatric intensive care unit; Prognosis; Risk factors; Mortality; KDIGO

Variables	Total	Non-survivors	Survivors	p
n	434	94 (22%)	340 (78%)
Age (months)	49 ± 47	53 ± 49	48 ± 46	0.54
Male (n, %)	246 (57%)	52 (55%)	194 (57%)	0.42
Weight (kg)	16.5 ± 12.7	16.8 ± 11.8	16.7 ± 12.9	0.66
Diagnosis at admission
Clinical	299 (69%)	84 (90%)	215 (63%)	0.001
Surgical	135 (31%)	10 (10%)	125 (37%)
PRISM II score	12.03 ± 8.2	17 ± 9	11 ± 7	<0.001
Mechanical ventilation^a a Data obtained during PICU stay. (n, %)	245 (56%)	92 (98%)	153 (45%)	0.001
Systolic blood pressure^a a Data obtained during PICU stay. (mmHg)	119 ± 26	105 ± 32	122 ± 23	<0.001
Vasoactive drug^a a Data obtained during PICU stay. (n, %)	155 (36%)	72 (76%)	83 (24%)	0.001
Diuresis (mL/kg/h)^b b Data obtained during the first 24 h of admission to the PICU.	3.1 ± 2.3	2.6 ± 2.2	3.8 ± 2.3	0.003
Fluid balance^b b Data obtained during the first 24 h of admission to the PICU. (mL/kg/24 h)	15.5 (2.2-39.8)	29 (8.7-57.3)	13.5 (1.5-33.2)	<0.001
AKI^a a Data obtained during PICU stay.	279 (64%)	88 (94%)	191 (56%)	0.001
Bicarbonate^b b Data obtained during the first 24 h of admission to the PICU.	17.8 (±6)	18.2 (±7.2)	17.7 (±5.6)	0.497
Potassium^b b Data obtained during the first 24 h of admission to the PICU.	3.9 (±1)	3.9 (±1.1)	3.9 (±1)	0.759
Creatinine^b b Data obtained during the first 24 h of admission to the PICU.	0.7 (±0.7)	0.9 (±0.7)	0.6 (±0.7)	<0.001

Variables	Total	With AKI	Without AKI	p
n	434	279 (64%)	155 (36%)
Age (months)	49 ± 47	42 ± 45	62 ± 47	<0.001
Male gender (n, %)	246 (57%)	157 (56%)	89 (57%)	0.76
Weight (kg)	16.5 ± 12.7	15.2 ± 12.6	19.6 ± 12.2	<0.001
Diagnosis at admission				<0.001
Clinical	299 (69%)	218 (78%)	81 (53%)
Surgical	135 (43%)	61 (22%)	74 (47%)
Diuresis (mL/kg/h)^a a Data obtained during the first 24 h of admission to the PICU.	3.1 ± 2.3	3.0 ± 2.5	3.3 ± 2.0	0.02
Fluid balance (mL/kg/h)	15.5 (2.2-39.8)	18.7 (4.0-46.4)	11.7 (0.6-28.6)	0.002
Use of diuretics (n, %)	72(16%)	67 (24%)	5 (3%)	<0.001
PRISM score	12.03 ± 8.2	13 ± 8	9 ± 6	<0.001
Mechanical ventilation^b b Data obtained during PICU stay. (n, %)	244 (56%)	196 (70%)	48 (31%)	0.001
Vasoactive drugs^b b Data obtained during PICU stay. (n, %)	154 (35%)	137 (49%)	17 (11%)	<0.001
Mortality	94 (41%)	88 (94%)	6 (6%)	<0.001

Variables	OR	95% CI	p
Diuresis^a a Increase in the decile variable.	0.84	0.74 - 0.95	0.005
Age^a a Increase in the decile variable.	0.99	0.98 - 0.99	<0.001
Mechanical ventilation	2.32	1.32 - 4.08	0.003
Vaso active drug use	3.99	1.95 - 8.15	<0.001
Diuretic use	4.9	1.57 - 15.2	0.005
Amphotericin use	5.06	1.93 - 13.1	<0.001

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[1] * Corresponding author. E-mail: Corresponding author. marinacatuta@hotmail.com (M.C. Ferreira).

Variables	Hospital mortality
Variables	OR	95%CI	p
Weight^a a Decrease in the decile variable.	1.2	1.02-2.1	0.002
Fluid overload^b b Increase in the decile variable.	2.3	1.2-3.01	0.036
AKI	3.3	1.09-13.43	0.011
Dopamine	4.85	1.59-14.77	0.005
Mechanical ventilation	19.1	2.14-17.05	0.008

Variables	Long-term mortality
Variables	OR	95%CI	p
Systolic blood pressure^a a Decrease in the decile variable.	1.09	1.04-1.14	0.001
PRISM^b b Increase in the decile variable. score	1.11	1.04-1.18	0.001
Diuresis^a a Decrease in the decile variable.	2.21	1.2-4.07	0.011
Mechanical ventilation	4.61	2.36-9.02	0.012