Acute Renal Failure in Septic Children
Background and objective: Researchers discuss the influence of acute kidney failure on outcomes of septic pediatric patients. The aim of our study was to determine the pathogens of sepsis, prevalence of acute kidney failure (AKF) in septic children, and outcomes depending on the severity of sepsis.
Materials and methods: Retrospective analysis of medical records data of 206 pediatric patients treated for sepsis at the Hospital of Lithuanian University of Health Sciences Kauno klinikos Department of Children Diseases during the period 2013–2016 years was performed. The patients were divided into 2 groups: group 1 – patients with sepsis, and group 2 – patients with severe sepsis. Patients in the sepsis group had generalized infection complicated by one organ dysfunction. Severe sepsis was diagnosed when sepsis was associated with cardiovascular dysfunction, acute respiratory distress syndrome (ARDS), or dysfunction in two or more other organ systems [1].
Results: 206 pediatric patients (92 girls, 44.7%; 114 boys, 55.3%) aged from 1 month to 18 years were included into the study. N. meningitidis was the prevalent pathogen in blood cultures in both patients groups. Acute kidney failure (AKF) was diagnosed in 22 patients (10.7%): 5 (2.7%) in the sepsis group and 17 (70.8%) in the severe sepsis group (P < 0.001). Renal replacement therapy was administered to 9 patients (40.1%). The mortality rate in the study cohort was 10 (4.9%), while the mortality rate in the AKF and severe sepsis group was 7 (41.2%). Patients in the severe sepsis group statistically significantly more frequently were admitted to pediatric intensive care unit (PICU) (95% CI 5.337–306.196, OR 40.424) and had longer duration of hospitalization in PICU (95% CI 1.079–1.299, OR 1.184). The duration in PICU was >5 days (95% CI 4.272–34.956, OR 12.22), causative microorganism N. Meningitidis (95% CI 2.058, 4.272-34.956, OR 2.058).
Conclusions: Streptococcus and Staphylococcus were the leading causative factors in the sepsis group, while N. meningitidis was in the severe sepsis group. Acute kidney failure was more common in the severe sepsis group. The mortality rate in the AKF and severe sepsis group was 41.2% and the mortality rate in the study cohort was 4.9%.
Correspondence to . Rudaitis Department of Pediatrics, Lithuanian University of Health Sciences, Eivenių 2, LT‑50161 Kaunas, Lithuania Email: sarunas.rudaitis@kaunoklinikos.lt