MORTALITY rates were found to be higher in children admitted to hospital with severe sepsis who had a concurrent acute kidney injury (AKI), according to a new retrospective analysis.
In light of the documented rise in rates of AKI in paediatric sepsis cases, a team, headed by Aravind Thavamani, University Hospitals Rainbow Babies & Children’s Hospital, Cleveland, Ohio, USA, reviewed data from 192,712 paediatric hospitalisations for severe sepsis in order to assess whether AKI affected patient outcomes. These included in-hospital mortality, length of stay, and total hospitalisation charges. The data being analysed was of children, aged between 1–18 years, who were hospitalised with severe sepsis between 2003–2019.
The analysis revealed that AKI occurred in 23.6% of the total cases and in-hospital mortality was 11.7% higher in paediatric patients with severe sepsis who had an AKI than in patients with severe sepsis and no AKI. The mortality rate for those with severe sepsis and AKI was 19.8% versus 8.1% in those with severe sepsis alone. The authors also identified that patients with comorbidities such as diabetes, HIV, malnutrition, organ transplant, and urinary tract abnormalities were more likely to develop an AKI compared with patients who did not. Additionally, multivariate logistic regression analysis highlighted that compared to admissions with severe sepsis and no AKI, the odds of mortality for those with severe sepsis and an AKI not requiring renal replacement therapy was 3.0-times higher, and higher still in those with severe sepsis and an AKI requiring renal replacement therapy, who displayed 6.4-times increased odds of mortality.
Moreover, those with severe sepsis and AKI experienced longer hospital admissions and higher hospitalisation costs that those with severe sepsis and no AKI, with a 14-day and 11-day median length of stay, respectively.
These findings highlight the impact of AKI on outcomes for paediatric patients with severe sepsis and spotlights a need for prevention as well as early identification and treatment of AKI in such cases to improve these outcomes. Furthermore, early identification and intervention could also help to reduce admission lengths and reduce healthcare costs.
