Risk factors for occurrence and death of sepsis-associated acute kidney injury in children with sepsis

Introduction: The 28th Acute Disease Quality Initiative (ADQI) Workgroup proposed the first international consensus on definition of SA-AKI in June 2023. The incidence and mortality of ADQI-defined SA-AKI in septic children is unknown, and the risk factors for the occurrence and death of SA-AKI is unexplored. Methods: We conducted a retrospective study of septic children between January 1, 2018 and December 31, 2022. Logistic regression analysis was used to identify risk factors for SA-AKI. COX proportional hazards regression analysis was utilized for analyzing the risk factors for 30-day mortality in SA-AKI and septic children. Results: 221 children were included, of which 81 (36.7 %) developed SA-AKI, with 25.9 % developed into acute kidney disease. Older age, lower baseline eGFR and mechanical ventilation were independently associated with SA-AKI (P < 0.001, P < 0.01 and P < 0.05 respectively). Among the 81 SA-AKI children, 32.1 % died within 30 days from sepsis diagnosis, with higher mortality in children with late SA-AKI than early SA-AKI (72.2 % versus 20.6 %, P < 0.001). Septic shock was independently associated with 30-day death in SA-AKI children (P < 0.05). The overall 30-day mortality of septic children was 19.0 %, with mechanical ventilation, SA-AKI, and septic shock identified as independently associated with 30-day death (P < 0.001, P < 0.05 and P < 0.001 respectively). Conclusions: SA-AKI is of high incidence and mortality in septic children. Older age, lower baseline eGFR and mechanical ventilation were independent risk factors for SA-AKI. SA-AKI was independently associated with 30-day mortality in septic children.