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25.07.2020 | Original Article

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

verfasst von: Julie C. Fitzgerald, Michelle E. Ross, Neal J. Thomas, Scott L. Weiss, Fran Balamuth, Marianne Chilutti, Robert W. Grundmeier, Amanda Hyre Anderson

Erschienen in: Pediatric Nephrology | Ausgabe 2/2021

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Abstract

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.

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Titel: Association of early hypotension in pediatric sepsis with development of new or persistent acute kidney injury
verfasst von: Julie C. Fitzgerald
Michelle E. Ross
Neal J. Thomas
Scott L. Weiss
Fran Balamuth
Marianne Chilutti
Robert W. Grundmeier
Amanda Hyre Anderson
Publikationsdatum: 25.07.2020
Verlag: Springer Berlin Heidelberg
Erschienen in: Pediatric Nephrology / Ausgabe 2/2021
Print ISSN: 0931-041X
Elektronische ISSN: 1432-198X
DOI: https://doi.org/10.1007/s00467-020-04704-2

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