A Retrospective Analysis of Risk Factors and Impact of Acute Kidney Injury in Critically Ill Children

Abstract

Background Acute kidney injury (AKI) is a serious clinical condition in critically ill children and is associated with worse outcomes. A few pediatric studies focused on the risk factors of AKI. We aimed to identify the incidence, risk factors, and outcomes of AKI in the pediatric intensive care unit (PICU).

Patients and methods All the patients admitted to PICU over a period of 20 months were included. We compared both groups the risk factors between AKI and non-AKI.

Results A total of 63 patients (17.5%) of the 360 patients developed AKI during PICU stay. The presence of comorbidity, diagnosis of sepsis, increased PRISM III score, and positive renal angina index were found to be risk factors for AKI on admission. Thrombocytopenia, multiple organ failure syndrome, the requirement of mechanical ventilation, use of inotropic drugs, intravenous iodinated contrast media, and exposure to an increased number of nephrotoxic drugs were independent risk factors during the hospital stay. The patients with AKI had a lower renal function on discharge and had worse overall survival.

Conclusions AKI is prevalent and multifactorial in critically sick children. The risk factors of AKI may be present on admission and during the hospital stay. AKI is related to prolonged mechanical ventilation days, longer PICU stays, and a higher mortality rate. Based on the presented results early prediction of AKI and consequent modification of nephrotoxic medication may generate positive effects on the outcome of critically ill children.

Zusammenfassung

Hintergrund Die akute Nierenschädigung (AKI) ist ein schwerwiegender klinischer Zustand bei kritisch kranken Kindern und mit schlechteren Ergebnissen verbunden. Einige pädiatrische Studien konzentrierten sich auf die Risikofaktoren von AKI. Unser Ziel war es, die Inzidenz, Risikofaktoren und Ergebnisse von AKI auf der pädiatrischen Intensivstation (PICU) zu identifizieren.

Patienten und Methoden Alle Patienten, die von Mai 2020 bis Dezember 2021 auf der Intensivstation aufgenommen wurden, wurden eingeschlossen. Wir verglichen bei beiden Gruppen die Risikofaktoren zwischen AKI und Nicht-AKI.

Resultat Insgesamt 63 Patienten (17,5%) der 360 Patienten entwickelten AKI während des PICU-Aufenthaltes. Das Vorliegen einer Komorbidität, die Diagnose einer Sepsis, ein erhöhter PRISM-III-Score und ein positiver renaler Angina-Index erwiesen sich bei der Aufnahme als Risikofaktoren für AKI. Thrombozytopenie, multiples Organversagen, die Notwendigkeit einer mechanischen Beatmung, die Verwendung inotroper Medikamente, intravenöse jodhaltige Kontrastmittel und die Exposition gegenüber einer erhöhten Anzahl nephrotoxischer Medikamente waren unabhängige Risikofaktoren während des Krankenhausaufenthalts. Die Patienten mit AKI hatten bei der Entlassung eine niedrigere Nierenfunktion und ein schlechteres Gesamtüberleben.

Schlussfolgerungen AKI ist bei kritisch kranken Kindern weit verbreitet und multifaktoriell. Die Risikofaktoren von AKI können bei der Aufnahme und während des Krankenhausaufenthalts vorhanden sein. AKI steht im Zusammenhang mit verlängerten Tagen der mechanischen Beatmung, längeren Aufenthalten auf der PICU und einer höheren Sterblichkeitsrate. Basierend auf den vorgestellten Ergebnissen kann eine frühzeitige Vorhersage von AKI und eine konsequente Modifikation der nephrotoxischen Medikation positive Auswirkungen auf das Outcome kritisch kranker Kinder haben.

Key words

Acute kidney injury - critically ill children - pediatric intensive care unit - risk factors - nephrotoxic medications - renal angina index

Schlüsselwörter

Akute Nierenschädigung - schwerkranke Kinder - pädiatrische Intensivstation - Risikofaktoren - nephrotoxische Medikamente - renaler Angina-Index

Publikationsverlauf

Artikel online veröffentlicht:
27. Februar 2023

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