Predictive factors of mortality in pediatric patients with acute renal injury associated with sepsis<sup>,</sup>

Riyuzo, Marcia C.; Silveira, Liciana V. de A.; Macedo, Célia S.; Fioretto, José R.

doi:10.1016/j.jped.2016.04.006

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Original articles • J. Pediatr. (Rio J.) 93 (1) • Jan/Feb 2017 • https://doi.org/10.1016/j.jped.2016.04.006 copy

Predictive factors of mortality in pediatric patients with acute renal injury associated with sepsis^☆ ☆ Please cite this article as: Riyuzo MC, Silveira LV, Macedo CS, Fioretto JR. Predictive factors of mortality in pediatric patients with acute renal injury associated with sepsis. J Pediatr (Rio J). 2017;93:28-34. ^,^☆☆ ☆☆ Study conducted at Universidade Estadual Paulista (UNESP), Botucatu, SP, Brazil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract:

Objective:

To evaluate the prognosis factors of children with sepsis and acute kidney injury.

Methods:

This was a retrospective study of children with sepsis and acute kidney injury that were admitted to the pediatric intensive care unit (PICU) of a tertiary hospital. A multivariate analysis was performed to compare risk factors for mortality.

Results:

Seventy-seven children (47 males) were retrospectively studied, median age of 4 months. Mean length of hospital stay was 7.33 ± 0.16 days, 68.9% of patients received mechanical ventilation, 25.9% had oligo-anuria, and peritoneal dialysis was performed in 42.8%. The pRIFLE criteria were: injury (5.2%) and failure (94.8%), and the staging system criteria were: stage 1 (14.3%), stage 2 (29.9%), and stage 3 (55.8%). The mortality rate was 33.7%. In the multivariate analysis, the risk factors for mortality were PICU length of stay (OR = 0.615, SE = 0.1377, 95% CI = 0.469-0.805, p = 0.0004); invasive mechanical ventilation (OR = 14.599, SE = 1.1178, 95% CI = 1.673-133.7564, p = 0.0155); need for dialysis (OR = 9.714, SE = 0.8088, 95% CI = 1.990-47.410, p = 0.0049), and hypoalbuminemia (OR = 10.484, SE = 1.1147, 95% CI = 1.179-93.200, p = 0.035).

Conclusions:

The risk factors for mortality in children with acute kidney injury were associated with sepsis severity.

KEYWORDS
Acute kidney injury; Sepsis; Predictive factors; Mortality

Variable	Survived (n = 51)	Deceased (n = 26)	p ^a a Statistical analysis.
Age (months, median)	4	6	0.37^b b Mann-Whitney's U test.
Gender (male/female, n)	32/19	15/11	0.80^c c Fisher's exact test.
PICU admission (days, median)	8	4.5	0.001^b b Mann-Whitney's U test.
Diuresis (mL/kg/h, median)	2.0	1.4	0.19^b b Mann-Whitney's U test.
Oligoanuria (n)	9	11	0.039^c c Fisher's exact test.
Hypotension (n)/hypertension (n)	1/6	2/2	0.50^c c Fisher's exact test.
Vasoactive drug (n) 0/1/2 or more	1/4/46	0/1/25	0.77^c c Fisher's exact test.
Mechanical ventilation (n)	30	24	0.0015^c c Fisher's exact test.
Days on ventilation (median)	5	4	0.18^b b Mann-Whitney's U test.
Dialyzed (n)	14	19	0.0002^c c Fisher's exact test.
Acute kidney injury classification criteria:
pRIFLE
pRIFLE I n (%)	2 (4)	2 (7.6)	0.60^c c Fisher's exact test.
pRIFLE F n (%)	49 (96)	24 (92.4)	0.60^c c Fisher's exact test.
Staging system
Stage 1 n (%)	11 (21.6)	0	0.021^c c Fisher's exact test.
Stage 2 n (%)	13 (25.5)	10 (38.5)
Stage 3 n (%)	27 (52.9)	16 (61.5)

Variable	Survived (n = 51)	Deceased (n = 26)	p ^a a Statistical analysis.
Creatinine (mg/dL, median)	1.39	1.69	0.27^b b Mann-Whitney's U test.
Urea (mg/dL, median)	111	89	0.40^b b Mann-Whitney's U test.
Albumin (g/dl, mean ± SD)	3.13 ± 0.93	2.30 ± 0.70	0.006^b b Mann-Whitney's U test.
Bicarbonate (mEq/L, mean ± SD)	7.39 ± 5.29	11.11 ± 6.58	0.01^b b Mann-Whitney's U test.
Calcium (mg/dL, median)	8.6	8.45	0.62^b b Mann-Whitney's U test.
Hypocalcemia (n)	19	7	0.99^c c Fisher's exact test.
Potassium (mEq/L, median)	4	3.9	0.53^b b Mann-Whitney's U test.
Hyperkalemia (n)	6	3	1.00^c c Fisher's exact test.
Hypokalemia (n)	14	9	0.70^c c Fisher's exact test.
Sodium (mEq/L, median)	138	138	0.44^b b Mann-Whitney's U test.
Hyponatremia (n)	10	11	0.065^c c Fisher's exact test.
Glucose (mg/dL, median)	121	110	0.53^b b Mann-Whitney's U test.
Hypoglycemia (n)	1	3	0.29^c c Fisher's exact test.
Hyperglycemia (n)	11	8	0.98^c c Fisher's exact test.
Hematocrit (%, mean ± SD)	28.7 ± 5.81	29.9 ± 4.9	0.37^b b Mann-Whitney's U test.
Thrombocytopenia (n)	3	8	0.015^c c Fisher's exact test.
Proteinuria (n)	29	10	1.00^c c Fisher's exact test.

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[1] * Corresponding author. E-mail:mriyuzo@fmb.unesp.br (M.C. Riyuzo).