Erin Hessey1, Geneviève Morissette2, Jacques Lacroix3, Sylvie Perreault4, Susan Samuel5, Marc Dorais6, Philippe Jouvet3, Jean-Philippe Lafrance7,8, Jacques LeLorier8, Véronique Phan9, Ana Palijan1, Michael Pizzi1, Louise Roy10, Michael Zappitelli11. 1. Division of Nephrology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Canada. 2. Pediatric Intensive Care Unit, Department of Pediatrics, Centre mère-enfant Soleil, Centre Hospitalier de l'Université Laval, Quebec, Canada. 3. Pediatric Intensive Care Unit and. 4. Pharmacy, Université de Montréal, Montreal, Canada. 5. Division of Nephrology, Department of Pediatrics, Alberta Children's Hospital, Calgary, Canada. 6. StatScience Inc, Notre-Dame-de-l'Île-Perrot, Quebec, Canada; and. 7. Division of Nephrology, Department of Medicine, Hôpital Maisonneuve-Rosemont, Montreal, Canada. 8. Pharmacology and Physiology, Faculties of Medicine, and. 9. Division of Nephrology, Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Canada. 10. Division of Nephrology, Departments of Medicine. 11. Division of Nephrology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Canada; Michael.zappitelli@sickkids.ca.
Abstract
OBJECTIVES: (1) To evaluate the association between acute kidney injury (AKI) in the PICU and long-term mortality and (2) to determine the extent to which adding the urine output (UO)-defined AKI alters the association. METHODS: A 2-center retrospective cohort study of children (≤18 years old) admitted to the PICU between 2003 and 2005 for noncardiac surgery, with follow-up until 2010. Patients with end stage renal disease, no provincial health insurance number, who died during hospitalization, or could not be linked to administrative data were excluded. One hospitalization per patient was included. AKI was defined by using serum creatinine criteria and/or UO criteria. Mortality was ascertained by using administrative data. Cox regression analysis was performed to evaluate the association between AKI and long-term mortality. RESULTS: The study population included 2041 patients (55.7% male, mean admission age 6.5 ± 5.8 years). Of 2041 hospital survivors, 9 (0.4%) died within 30 days, 51 (2.5%) died within 1 year, and 118 (5.8%) died within 5 to 7 years postdischarge. AKI was independently associated with 5- to 7-year mortality (adjusted hazard ratio [95% confidence interval]: 3.10 [1.46-6.57] and 3.38 [1.63-7.02], respectively). Including UO did not strengthen the association. CONCLUSIONS: AKI is associated with 5- to 7-year mortality. Because this is an observational study we cannot determine if AKI is causative of mortality or of the pathophysiology. However, patients with AKI represent a high-risk group. It is reasonable that these patients be considered for targeted follow-up until future researchers better elucidate these relationships.
OBJECTIVES: (1) To evaluate the association between acute kidney injury (AKI) in the PICU and long-term mortality and (2) to determine the extent to which adding the urine output (UO)-defined AKI alters the association. METHODS: A 2-center retrospective cohort study of children (≤18 years old) admitted to the PICU between 2003 and 2005 for noncardiac surgery, with follow-up until 2010. Patients with end stage renal disease, no provincial health insurance number, who died during hospitalization, or could not be linked to administrative data were excluded. One hospitalization per patient was included. AKI was defined by using serum creatinine criteria and/or UO criteria. Mortality was ascertained by using administrative data. Cox regression analysis was performed to evaluate the association between AKI and long-term mortality. RESULTS: The study population included 2041 patients (55.7% male, mean admission age 6.5 ± 5.8 years). Of 2041 hospital survivors, 9 (0.4%) died within 30 days, 51 (2.5%) died within 1 year, and 118 (5.8%) died within 5 to 7 years postdischarge. AKI was independently associated with 5- to 7-year mortality (adjusted hazard ratio [95% confidence interval]: 3.10 [1.46-6.57] and 3.38 [1.63-7.02], respectively). Including UO did not strengthen the association. CONCLUSIONS: AKI is associated with 5- to 7-year mortality. Because this is an observational study we cannot determine if AKI is causative of mortality or of the pathophysiology. However, patients with AKI represent a high-risk group. It is reasonable that these patients be considered for targeted follow-up until future researchers better elucidate these relationships.
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Authors: Erin Hessey; Nabil Melhem; Rashid Alobaidi; Emma Ulrich; Catherine Morgan; Sean M Bagshaw; Manish D Sinha Journal: Front Pediatr Date: 2021-03-15 Impact factor: 3.418
Authors: Emma H Ulrich; Erin Hessey; Sylvie Perreault; Marc Dorais; Philippe Jouvet; Veronique Phan; Michael Zappitelli Journal: Crit Care Explor Date: 2022-01-18
Authors: David D'Arienzo; Erin Hessey; Rami Ali; Sylvie Perreault; Susan Samuel; Louise Roy; Jacques Lacroix; Philippe Jouvet; Genevieve Morissette; Marc Dorais; Jean-Philippe Lafrance; Veronique Phan; Michael Pizzi; Rahul Chanchlani; Michael Zappitelli Journal: Can J Kidney Health Dis Date: 2019-02-10