Risk Factors And Prognosis Of Acute Kidney Injury In Children With Sepsis In Pediatric Intensive Care Unit

Background and Objective:Acute kidney injury(AKI)is becoming more common in pediatric intensive care unit(PICU)with serious adverse consequences.Early recognition intervention can significantly improve the prognosis and reduce the mortality.There are many studies on sepsis complicated with AKI in adults,but few reports on the risk factors of sepsis complicated with AKI in children.In this study,by analyzing the related factors affecting the incidence and prognosis of AKI in sepsis in PICU,early intervention measures were found and implemented in time to reduce the morbidity and mortality of AKIMethods:Retrospective analysis of clinical data of PICU sepsis children in Anhui Children’s Hospital from May 2015 to May 2018,The children were divided into AKI group and non-AKI group[referring to the diagnostic criteria for improving the prognosis of global kidney disease(KDIGO)]according to whether AKI occurred within 48 hours of PICU.Exclusion time in ICU<48h;Previous history of kidney disease,acute or chronic renal failure,kidney transplantation;Application of nephrotoxic drugs or contrast agents;In children with AKI caused by postrenal factors such as urinary tract obstruction.The general data,physiological data and clinical outcomes of the two groups were compared;Logistic regression analysis was used to analyze the risk factors of AKI in children with sepsis and the prognostic factorsResults:AKI occurred in 55 of 127 children with sepsis,the incidence of AKI was 43.3%,and the overall fatality rate was 28.3%(36/127),of which 41.8%(23/55)in AKI group and 18.1%(13/72)in non-AKI group.(1)Compared with non-AKI group,oxygenation index,leucocyte,albumin,the pediatric critical illness case score(PCIS)score and urine volume in AKI group decreased significantly,while cystatin C,procalcitonin(PCT),prothrombin time(PT),activated partial thromboplastin time(APTT),pediatric multiple organ dysfunction score(P-MODS),the proportions of mechanical ventilation,vascular active drug use rate,combined shock,septic shock and mortality were significantly increased,while the differences in age,gender,mean arterial pressure and c-reactive protein(CRP)between the two groups were not statistically significant.Multivariate Logistic regression analysis showed that serum albumin[odds ratio(OR)=0.627,95%CI=0.495-0.794,P=0.000]was the protective factor of AKI in sepsis,and cystatin C(OR=2.641,95%CI=1.157-6.032,P=0.021)was the risk factor for AKI in children with sepsis.(2)Compared with the survival group of children with sepsis AKI,the proportion of mechanical ventilation,septic shock,vasoactive drug use,positive balance ratio of liquid for 72h,6h lactate clearance rate<10%,and AKI3-stage patients in the death group of children with sepsis AKI were significantly increased.Multivariate Logistic regression analysis showed that 72h positive liquid balance(OR=8.542,95%CI=1.956-37.307,P=0.004)and 6h lactate clearance rate<10%(OR=5.98,95%CI=1.393-37.676,P=0.016)were risk factors for the death of children with sepsis AKIConclusions:Positive fluid balance for 72h and lactic acid clearance rate for 6h are risk factors for death of children with sepsis complicated with AKI.Early detection and intervention for treatment can reduce the mortality rate of sepsis complicated with AKI.