title: Acute Kidney Injury in Pediatric Severe Sepsis: An Independent Risk Factor for Death and New Disability.
abstract: OBJECTIVE
  The prevalence of septic acute kidney injury and impact on functional status of PICU survivors are unknown. We used data from an international prospective severe sepsis study to elucidate functional outcomes of children suffering septic acute kidney injury.
  
  
  METHODS
  Secondary analysis of patients in the Sepsis PRevalence, OUtcomes, and Therapies point prevalence study: acute kidney injury was defined on the study day using Kidney Disease Improving Global Outcomes definitions. Patients with no acute kidney injury or stage 1 acute kidney injury ("no/mild acute kidney injury") were compared with those with stage 2 or 3 acute kidney injury ("severe acute kidney injury"). The primary outcome was a composite of death or new moderate disability at discharge defined as a Pediatric Overall Performance Category score of 3 or higher and increased by 1 from baseline.
  
  
  METHODS
  One hundred twenty-eight PICUs in 26 countries.
  
  
  METHODS
  Children with severe sepsis in the Sepsis PRevalence, OUtcomes, and Therapies study.
  
  
  METHODS
  None.
  
  
  RESULTS
  One hundred two (21%) of 493 patients had severe acute kidney injury. More than twice as many patients with severe acute kidney injury died or developed new moderate disability compared with those with no/mild acute kidney injury (64% vs 30%; p < 0.001). Severe acute kidney injury was independently associated with death or new moderate disability (adjusted odds ratio, 2.5; 95% CI, 1.5-4.2; p = 0.001) after adjustment for age, region, baseline disability, malignancy, invasive mechanical ventilation, albumin administration, and the pediatric logistic organ dysfunction score.
  
  
  CONCLUSIONS
  In a multinational cohort of critically ill children with severe sepsis and high mortality rates, septic acute kidney injury is independently associated with further increased death or new disability.
authors: 1Department of Anesthesiology and Critical Care, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.2Department of Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.3Division of Critical Care Medicine and the Center for Acute Care Nephrology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.4Sections of Critical Care and Renal, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX.5Division of Pediatric Critical Care Medicine, Hospital Militar Central, Bogotá, Colombia.6Department of Pediatric Critical Care Medicine, Pablo Tobón Uribe Hospital, Medellín, Colombia.7Department of Pediatrics, State University of New York at Buffalo, Jacobs School of Medicine and Biomedical Sciences, and Division of Pediatric Critical Care, Women and Children's Hospital of Buffalo, Buffalo, NY.8Department of Pediatrics, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Katowice, Poland.9Paediatric Intensive Care Unit, Department of Child Health, King's College Hospital, London, United Kingdom.10Division of Pediatric Critical Care Medicine, Department of Pediatrics, Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, VA.11Division of Critical Care Medicine, Department of Pediatrics, University of California, San Francisco, San Francisco, CA.12Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.13Division of Pediatric Critical Care Medicine, Penn State Hershey Children's Hospital, Penn State University College of Medicine, Hershey, PA.
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mesh_terms: D058186:Acute Kidney Injury / Q000150:complications* / Q000453:epidemiology / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D019988:Children with Disabilities / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data; D008297:Male; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000150:complications* / Q000453:epidemiology / Q000401:mortality; D016896:Treatment Outcome