Increasing incidence of acute kidney injury in pediatric severe sepsis and related adverse hospital outcomes

Background Pediatric severe sepsis (PSS) is associated with increased mortality, and acute kidney injury (AKI) is an independent risk factor of mortality in PSS. However, there is little data on impact of AKI on hospital outcomes in PSS.Methods We analyzed non-overlapping years of the Kids' Inpatient Database (KID) and National Inpatient Sample (NIS) database between 2003 and 2019 of all pediatric patients with severe sepsis between 1 and 18 years of age. Using ICD diagnosis codes, patients were divided into two groups based on AKI status and compared for outcomes measures including in-hospital mortality and healthcare resource utilization using length of stay and inflation-adjusted hospitalization charges.Results We analyzed 192,712 hospitalizations due to PSS during the 17-year period. Prevalence of AKI was 23.6% with overall increasing trend, P < 0.001. Prevalence of AKI was significantly increased in patients with diabetes mellitus, organ transplantation, HIV, urinary tract anomalies, and malnutrition, P < 0.001. Mortality rate was significantly higher among patients with AKI (19.8% vs. 8.1%, P < 0.001). PSS with AKI had significantly higher median length of stay (14 vs. 11 days) and total hospitalization charges ($168,106 vs. 100,906), P < 0.001. Multivariate logistic regression analysis showed that AKI without kidney replacement therapy (KRT) was associated with 3.02 times increased odds of mortality (95% CI 2.99-3.17, P < 0.001) and those requiring KRT had 6.4 times increased odds of mortality (95%CI 6.1-6.7, P < 0.001). AKI without KRT was associated with 7.7 (95% CI 7.3-8.05) additional days of hospitalization and 154,536 (95% CI 149,500-159,572) additional US dollars in hospitalization charges.Conclusion Almost 1 in 4 hospitalizations with PSS had AKI and was associated with > 3 times increased risk of mortality and need for KRT further adversely impacts mortality and healthcare utilization.

Automated summary

Pediatric severe sepsis (PSS) is associated with increased mortality, and acute kidney injury (AKI) is an independent risk factor for mortality. This study analyzed data of pediatric patients with PSS from two databases between 2003 and 2019, and compared outcomes between patients with and without AKI. The results showed that AKI was prevalent in PSS patients and was associated with higher mortality rate, longer hospital stay, and increased hospitalization charges. The need for kidney replacement therapy further worsened the outcomes.