Association of early hypotension in pediatric sepsis with development of new or persistent acute kidney injury

Objective To determine how hypotension in the first 48 h of sepsis management impacts acute kidney injury (AKI) development and persistence. Study design Retrospective study of patients > 1 month to < 20 years old with sepsis in a pediatric ICU between November 2012 and January 2015 (n = 217). All systolic blood pressure (SBP) data documented within 48 h after sepsis recognition were collected and converted to percentiles for age, sex, and height. Time below SBP percentiles and below pediatric advanced life support (PALS) targets was calculated by summing elapsed time under SBP thresholds during the first 48 h. The primary outcome was new or persistent AKI, defined as stage 2 or 3 AKI present between sepsis day 3-7 using Kidney Disease: Improving Global Outcomes creatinine definitions. Secondary outcomes included AKI-free days (days alive and free of AKI) and time to kidney recovery. Results Fifty of 217 sepsis patients (23%) had new or persistent AKI. Patients with AKI spent a median of 35 min under the first SBP percentile, versus 4 min in those without AKI. After adjustment for potential confounders, the odds of AKI increased by 9% with each doubling of minutes spent under this threshold (p = 0.03). Time under the first SBP percentile was also associated with fewer AKI-free days (p = 0.02). Time spent under PALS targets was not associated with AKI. Conclusions The duration of severe systolic hypotension in the first 48 h of pediatric sepsis management is associated with AKI incidence and duration when defined by age, sex, and height norms, but not by PALS definitions.

Automated summary

In the first 48 hours of pediatric sepsis management, the duration of severe systolic hypotension is associated with the incidence and duration of AKI when defined by age, sex, and height norms, but not by PALS definitions. Patients with AKI spent more time under the first SBP percentile compared to those without AKI, and for each doubling of time spent under this threshold, the odds of AKI increased by 9%. Time spent under PALS targets was not associated with AKI.