Major Adverse Kidney Events in Pediatric Sepsis.

Authors:
Scott L Weiss
Scott L Weiss
The Children's Hospital of Philadelphia
Philadelphia | United States
Fran Balamuth
Fran Balamuth
The Children's Hospital of Philadelphia
Cary W Thurm
Cary W Thurm
Children's Hospital Association
Kevin J Downes
Kevin J Downes
Cincinnati Children's Hospital Medical Center
United States
Julie C Fitzgerald
Julie C Fitzgerald
The Children's Hospital of Philadelphia
United States
Benjamin L Laskin
Benjamin L Laskin
The Children's Hospital of Philadelphia
Philadelphia | United States

Clin J Am Soc Nephrol 2019 May 18;14(5):664-672. Epub 2019 Apr 18.

Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.

Background And Objectives: Major adverse kidney events, a composite of death, new kidney replacement therapy, or persistent kidney dysfunction, is a potential patient-centered outcome for clinical trials in sepsis-associated kidney injury. We sought to determine the incidence of major adverse kidney events within 30 days and validate this end point in pediatric sepsis.

Design, Setting, Participants, & Measurements: We conducted a retrospective observational study using the Pediatric Health Information Systems Plus database of patients >6 months to <18 years old with a diagnosis of severe sepsis/septic shock; orders for bacterial blood culture, antibiotics, and at least one fluid bolus on hospital day 0/1; and known hospital disposition between January 2007 and December 2011. The primary outcome was incidence of major adverse kidney events within 30 days. Major adverse kidney events within 30 days were validated against all-cause mortality at hospital discharge, hospital length of stay, total hospital costs, hospital readmission within 30 days and 1 year, and lowest eGFR between 3 months and 1 year after discharge. We reported incidence of major adverse kidney events within 30 days with 95% confidence intervals using robust SEM and used multivariable logistic regression to test the association of major adverse kidney events within 30 days with hospital costs and mortality.

Results: Of 1685 admissions, incidence of major adverse kidney events within 30 days was 9.6% (95% confidence interval, 8.1% to 11.0%), including 4.5% (95% confidence interval, 3.5% to 5.4%) death, 1.7% (95% confidence interval, 1.1% to 2.3%) kidney replacement therapy, and 5.8% (95% confidence interval, 4.7% to 6.9%) persistent kidney dysfunction. Patients with versus without major adverse kidney events within 30 days had higher all-cause mortality at hospital discharge (28% versus 1%; <0.001), higher total hospital costs ($61,188; interquartile range, $21,272-140,356 versus $28,107; interquartile range, $13,056-72,697; <0.001), and higher proportion with eGFR<60 ml/min per 1.73 m between 3 months and 1 year after discharge (19% versus 4%; =0.001). Major adverse kidney events within 30 days was not associated with length of stay or readmissions.

Conclusions: In children with sepsis, major adverse kidney events within 30 days are common, feasible to measure, and a promising end point for future clinical trials.

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Source
http://dx.doi.org/10.2215/CJN.12201018DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6500940PMC
May 2019
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