Major adverse kidney events in pediatric sepsis

Background and objectives Major adverse kidney events, a composite of death, new kidney replacement therapy, or persistent kidney dysfunction, is a potential patient-centered outcome for clinical trials in sepsis-associated kidney injury.We sought to determine the incidence ofmajor adverse kidney events within 30 days and validate this end point in pediatric sepsis. Design, setting, participants, & measurements We conducted a retrospective observational study using the Pediatric Health Information Systems Plus database of patients >6 months to <18 years old with a diagnosis of severe sepsis/septic shock; orders for bacterial blood culture, antibiotics, and at least one fluid bolus on hospital day 0/1; and known hospital disposition between January 2007 and December 2011. The primary outcome was incidence of major adverse kidney events within 30 days. Major adverse kidney events within 30 days were validated against all-cause mortality at hospital discharge, hospital length of stay, total hospital costs, hospital readmissionwithin30days and1year, andlowest eGFRbetween3months and1year afterdischarge.Wereported incidence ofmajoradverse kidneyevents within30days with 95%confidence intervalsusing robustSEMandused multivariable logistic regression to test the association ofmajor adverse kidney eventswithin30dayswithhospital costs and mortality. Results Of 1685 admissions, incidence of major adverse kidney events within 30 days was 9.6% (95% confidence interval, 8.1% to 11.0%), including 4.5% (95% confidence interval, 3.5% to 5.4%) death, 1.7% (95% confidence interval, 1.1% to 2.3%) kidney replacement therapy, and 5.8% (95% confidence interval, 4.7% to 6.9%) persistent kidneydysfunction. Patientswithversuswithoutmajor adverse kidney eventswithin 30days hadhigher all-cause mortality at hospital discharge (28% versus 1%; P<0.001), higher total hospital costs ($61,188; interquartile range, $21,272-140,356 versus $28,107; interquartile range, $13,056-72,697; P<0.001), and higher proportion with eGFR<60 ml/min per 1.73 m² between 3 months and 1 year after discharge (19% versus 4%; P=0.001). Major adverse kidney events within 30 days was not associated with length of stay or readmissions. Conclusions In childrenwith sepsis,major adverse kidney events within 30 days are common, feasible tomeasure, and a promising end point for future clinical trials.