9 - Patterns of acute kidney injury and functional outcome scores in pediatric patients hospitalized with acute respiratory distress syndrome

Poster Number: 9
Publication Number: 9.107

Jacob C. Little, Seattle Children's, Seattle, WA, United States; Reid WD. Farris, University of Washington School of Medicine, Seattle, WA, United States; Noel S. Weiss, University of Washington, Shoreline, WA, United States; Jerry Zimmerman, University of Washington School of Medicine, Seattle, WA, United States; Shina Menon, University of Washington School of Medicine, Seattle, WA, United States

Background: Acute kidney injury (AKI) is diagnosed in up to 30% of children admitted to pediatric intensive care units (PICU) and is strongly associated with morbidity and mortality. In recent years, there has been an increased focus on patient-centered outcomes and quality of life for survivors of AKI. One study of pediatric sepsis patients with AKI found that AKI was independently associated with worsened functional status (FS) among survivors.

Objective: 1. Describe the frequency of AKI in children diagnosed with acute respiratory distress syndrome (ARDS).
2. Determine association between AKI and worsened FS after PICU stay among survivors.

Design/Methods: This was a single-center retrospective study at a tertiary care PICU that included children aged 3 months-18 years admitted to the PICU with ARDS requiring mechanical ventilation from 01/2013-10/2020.  ARDS was defined as a primary or secondary visit diagnosis in the EMR during the ICU admission of interest. Children who died in the first 3 days of ICU admission were excluded (n=36). AKI was defined using KDIGO serum creatinine (SCr) criteria. Severe AKI was defined as AKI Stage 2/3. Pediatric Cognitive Performance Category (PCPC) and Pediatric Overall Performance Category (POPC) scores from pre-ICU baseline and ICU discharge were analyzed. New substantive morbidity was defined as an increase in PCPC or POPC by ≥1 point.

Results: Final analysis included 324 patients. Severe AKI was seen in 23.1% of patients. Among survivors (92%), new substantive PCPC morbidity was seen in 7.0% of those with severe AKI compared to 1.7% in no/Stage 1 AKI.  New substantive POPC morbidity was also more common in survivors with severe AKI (21.1% vs 13.3% in no/Stage 1 AKI). After adjusting for age and PRISM III (excluding SCr), the association between severe AKI and new substantive morbidity among survivors persisted but was somewhat reduced in size (adjusted risk difference 5.5%; 95% CI -7.8%-18.8%). ICU mortality was higher in patients with severe AKI compared to no/Stage 1 AKI (24.0% vs 6.4%, respectively) and this association also was slightly weakened after adjustment (adjusted risk difference 15.8%; 95% CI 5.5%-26.1%).

Conclusion(s): AKI is commonly seen in children with ARDS and is strongly associated with ICU mortality. In our study, there was a suggestion that AKI also was independently associated with worsened FS at time of ICU discharge, but this result was statistically imprecise. Further research using more sensitive scales, such as the Functional Status Score, may be needed to better elucidate this relationship.