Akash Deep1,2, Gaurang Upadhyay1, Pascale du Pré3, Jon Lillie4, Daniel Pan5, Nadeesha Mudalige6, Hari Krishnan Kanthimathinathan7, Mae Johnson3, Shelley Riphagen4, Buvana Dwarakanathan8, Dusan Raffaj9, Santosh Sundararajan10, Patrick Davies9, Zoha Mohammad11, Nayan Shetty12, Stephen Playfor13, Michelle Jardine14, Oliver Ross15, Richard Levin16, Gareth Waters4, Ruchi Sinha17, Barnaby R Scholefield7,18, Elizabeth Boot4, Ashwani Koul19, Xabier Freire-Gomez4, Padmanabhan Ramnarayan17,20. 1. Pediatric Intensive Care Unit, King's College Hospital NHS Foundation Trust, London, United Kingdom. 2. Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, United Kingdom. 3. Pediatric Intensive Care Unit, Great Ormond Street Hospital, London, United Kingdom. 4. Pediatric Intensive Care Unit, Evelina Children's Hospital, London, United Kingdom. 5. Department of Respiratory Sciences, University of Leicester, Leicester, United Kingdom. 6. UCL Great Ormond Street Institute of Child Health, London, United Kingdom. 7. Pediatric Intensive Care Unit, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, United Kingdom. 8. Pediatric Intensive Care Unit, St George's Hospital, London, United Kingdom. 9. Pediatric Critical Care Unit, Nottingham Children's Hospital, Nottingham, United Kingdom. 10. Pediatric Intensive Care Unit, Leeds Children's Hospital, Leeds, United Kingdom. 11. Pediatric Intensive Care Unit, Leicester Royal Infirmary, Leicester, United Kingdom. 12. Pediatric Intensive Care Unit, Alder Hey Children's Hospital, Liverpool, United Kingdom. 13. Pediatric Intensive Care Unit, Royal Manchester Children's Hospital, Manchester, United Kingdom. 14. Pediatric Critical Care Unit, Children's Hospital for Wales, Cardiff, United Kingdom. 15. Pediatric Intensive Care Unit, Southampton Children's Hospital, Southampton, United Kingdom. 16. Pediatric Intensive Care Unit, Royal Hospital for Children, Glasgow, United Kingdom. 17. Pediatric Intensive Care Unit, St Mary's Hospital, London, United Kingdom. 18. Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom. 19. Pediatric Critical Care Unit, John Radcliffe Hospital, Oxford, United Kingdom. 20. Children's Acute Transport Service, Great Ormond Street Hospital NHS Foundation Trust and NIHR Biomedical Research Centre, London, United Kingdom.
Abstract
OBJECTIVES: To study the prevalence, evolution, and clinical factors associated with acute kidney injury in children admitted to PICUs with pediatric inflammatory multisystem syndrome temporally associated with severe acute respiratory syndrome coronavirus-2. DESIGN: Multicenter observational study. SETTING: Fifteen PICUs across the United Kingdom. PATIENTS: Patients admitted to United Kingdom PICUs with pediatric inflammatory multisystem syndrome temporally associated with severe acute respiratory syndrome coronavirus-2 between March 14, 2020, and May 20, 2020. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Deidentified data collected as part of routine clinical care were analyzed. All children were diagnosed and staged for acute kidney injury based on the level of serum creatinine above the upper limit of reference interval values according to published guidance. Severe acute kidney injury was defined as stage 2/3 acute kidney injury. Uni- and multivariable analyses were performed to study the association between demographic data, clinical features, markers of inflammation and cardiac injury, and severe acute kidney injury. Over the study period, 116 patients with pediatric inflammatory multisystem syndrome temporally associated with severe acute respiratory syndrome coronavirus-2 were admitted to 15 United Kingdom PICUs. Any-stage acute kidney injury occurred in 48 of 116 patients (41.4%) and severe acute kidney injury in 32 of 116 (27.6%) patients, which was mostly evident at admission (24/32, 75%). In univariable analysis, body mass index, hyperferritinemia, high C-reactive protein, Pediatric Index of Mortality 3 score, vasoactive medication, and invasive mechanical ventilation were associated with severe acute kidney injury. In multivariable logistic regression, hyperferritinemia was associated with severe acute kidney injury (compared with nonsevere acute kidney injury; adjusted odds ratio 1.04; 95% CI, 1.01-1.08; p = 0.04). Severe acute kidney injury was associated with longer PICU stay (median 5 days [interquartile range, 4-7 d] vs 3 days [interquartile range, 1.5-5 d]; p < 0.001) and increased duration of invasive mechanical ventilation (median 4 days [interquartile range, 2-6 d] vs 2 days [interquartile range, 1-3 d]; p = 0.04). CONCLUSIONS: Severe acute kidney injury occurred in just over a quarter of children admitted to United Kingdom PICUs with pediatric inflammatory multisystem syndrome temporally associated with severe acute respiratory syndrome coronavirus-2. Hyperferritinemia was significantly associated with severe acute kidney injury. Severe acute kidney injury was associated with increased duration of stay and ventilation. Although short-term outcomes for acute kidney injury in pediatric inflammatory multisystem syndrome temporally associated with severe acute respiratory syndrome coronavirus-2 appear good, long-term outcomes are unknown.
OBJECTIVES: To study the prevalence, evolution, and clinical factors associated with acute kidney injury in children admitted to PICUs with pediatric inflammatory multisystem syndrome temporally associated with severe acute respiratory syndrome coronavirus-2. DESIGN: Multicenter observational study. SETTING: Fifteen PICUs across the United Kingdom. PATIENTS: Patients admitted to United Kingdom PICUs with pediatric inflammatory multisystem syndrome temporally associated with severe acute respiratory syndrome coronavirus-2 between March 14, 2020, and May 20, 2020. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Deidentified data collected as part of routine clinical care were analyzed. All children were diagnosed and staged for acute kidney injury based on the level of serum creatinine above the upper limit of reference interval values according to published guidance. Severe acute kidney injury was defined as stage 2/3 acute kidney injury. Uni- and multivariable analyses were performed to study the association between demographic data, clinical features, markers of inflammation and cardiac injury, and severe acute kidney injury. Over the study period, 116 patients with pediatric inflammatory multisystem syndrome temporally associated with severe acute respiratory syndrome coronavirus-2 were admitted to 15 United Kingdom PICUs. Any-stage acute kidney injury occurred in 48 of 116 patients (41.4%) and severe acute kidney injury in 32 of 116 (27.6%) patients, which was mostly evident at admission (24/32, 75%). In univariable analysis, body mass index, hyperferritinemia, high C-reactive protein, Pediatric Index of Mortality 3 score, vasoactive medication, and invasive mechanical ventilation were associated with severe acute kidney injury. In multivariable logistic regression, hyperferritinemia was associated with severe acute kidney injury (compared with nonsevere acute kidney injury; adjusted odds ratio 1.04; 95% CI, 1.01-1.08; p = 0.04). Severe acute kidney injury was associated with longer PICU stay (median 5 days [interquartile range, 4-7 d] vs 3 days [interquartile range, 1.5-5 d]; p < 0.001) and increased duration of invasive mechanical ventilation (median 4 days [interquartile range, 2-6 d] vs 2 days [interquartile range, 1-3 d]; p = 0.04). CONCLUSIONS: Severe acute kidney injury occurred in just over a quarter of children admitted to United Kingdom PICUs with pediatric inflammatory multisystem syndrome temporally associated with severe acute respiratory syndrome coronavirus-2. Hyperferritinemia was significantly associated with severe acute kidney injury. Severe acute kidney injury was associated with increased duration of stay and ventilation. Although short-term outcomes for acute kidney injury in pediatric inflammatory multisystem syndrome temporally associated with severe acute respiratory syndrome coronavirus-2 appear good, long-term outcomes are unknown.
Authors: Hari Krishnan Kanthimathinathan; Hannah Buckley; Caroline Lamming; Peter Davis; Padmanabhan Ramnarayan; Richard Feltbower; Elizabeth S Draper Journal: Crit Care Explor Date: 2021-03-15
Authors: Houda Nassih; Sara Belghmaidi; Rabiy El Qadiry; Ibtissam Hajji; Aicha Bourrahouat; Abdeljalil Moutaouakil; Imane Ait Sab Journal: Glob Pediatr Health Date: 2022-07-22
Authors: Rajit K Basu; Erica C Bjornstad; Katja M Gist; Michelle Starr; Paras Khandhar; Rahul Chanchlani; Kelli A Krallman; Michael Zappitelli; David Askenazi; Stuart L Goldstein Journal: Pediatr Res Date: 2021-07-30 Impact factor: 3.953