Sepsis-Associated Acute Kidney Injury in the Paediatric Intensive Care Unit: Frequency and Outcomes

To assess the frequency and short-term outcomes of padietric patients admitted with sepsis-associated acute kidney injury (S-AKI) in the paediatric intensive care unit (PICU). A cross-sectional study. Place and Duration of the Study: Department of Paediatrics, The Aga Khan University Hospital, Karachi, Pakistan, from January 2021 to June 2022. Children aged 1 month to 18 years who were admitted to the PICU with a diagnosis of sepsis, based on the International Paediatric Sepsis Consensus (2005), were included. The p-RIFLE criteria was used to label AKI. Patients with chronic kidney disease or missing baseline creatinine at admission were excluded. The Chi-square test was used to study the association between variables. Logistic regression analysis was performed to compare AKI and non-AKI groups for different variables. Results are presented as mean with standard deviations and frequencies with percentages. During the study period, 1,114 patients were admitted to the PICU, of which 394 (35%) had sepsis. Three hundred and twenty-three patients met the inclusion criteria. The mean age of the study population was 2.49 ± 1.40 years, and 56 (17.3%) patients developed AKI. The mean length of PICU stay was 7.04 ± 6.47 days for children with AKI versus 5.24 ± 4.59 days for those without AKI. Of the 56 children with AKI, 44 (78.5%) received mechanical ventilation, and 10 (17.9%) underwent renal replacement therapy (RRT). Overall, 23.8% (n = 77) of patients expired during the study period ¾ 55 (20.59%) from the non-AKI group and 22 (39.22%) from the AKI group. Logistic regression analysis identified several factors associated with AKI, including hypotension at admission or during PICU stay (OR = 2.89, p = 0.002), oliguria (OR = 2.22, p = 0.028), raised BUN (OR = 3.51, p <0.001), and metabolic acidosis (OR = 2.79, p <0.001). Patients with S-AKI, on average, had a longer PICU stay and higher odds of mortality. Paediatrics, Paediatric intensive care unit, Acute kidney injury, Sepsis, p-RIFLE.