Acute kidney injury in critically Ill children and young adults with suspected SARS-CoV2 infection

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, SPARC Investigators, 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, SPARC Investigators

Abstract

Background: We aimed to study the association of suspected versus confirmed infection with the novel SARS-CoV2 virus with the prevalence of acute kidney injury (AKI) in critically ill children.

Methods: Sequential point-prevalence study of children and young adults aged 7 days to 25 years admitted to intensive care units under investigation for SARS-CoV2 infection. AKI was staged in the first 14 days of enrollment using KDIGO creatinine-based staging. SARS-CoV2 positive (CONFIRMED) were compared to SUSPECTED (negative or unknown). Outcome data was censored at 28-days.

Results: In 331 patients of both sexes, 179 (54.1%) were CONFIRMED, 4.2% (14) died. AKI occurred in 124 (37.5%) and severe AKI occurred in 63 (19.0%). Incidence of AKI in CONFIRMED was 74/179 (41.3%) versus 50/152 (32.9%) for SUSPECTED; severe AKI occurred in 35 (19.6%) of CONFIRMED and 28 (18.4%) of SUSPECTED. Mortality was 6.2% (n = 11) in CONFIRMED, but 9.5% (n = 7) in those CONFIRMED with AKI. On multivariable analysis, only Hispanic ethnicity (relative risk 0.5, 95% CI 0.3-0.9) was associated with less AKI development among those CONFIRMED.

Conclusions: AKI and severe AKI occur commonly in critically ill children with SARS-CoV2 infection, more than double the historical standard. Further investigation is needed during this continuing pandemic to describe and refine the understanding of pediatric AKI epidemiology and outcomes.

Trial registration: NCT01987921.

Impact: What is the key message of the article? AKI occurs in children exposed to the novel SARS-CoV2 virus at high prevalence (~40% with some form of AKI and 20% with severe AKI). What does it add to the existing literature? Acute kidney injury (AKI) occurs commonly in adult patients with SARS-CoV2 (COVID), very little data describes the epidemiology of AKI in children exposed to the virus. What is the impact? A pediatric vaccine is not available; thus, the pandemic is not over for children. Pediatricians will need to manage significant end-organ ramifications of the novel SARS-CoV2 virus including AKI.

Conflict of interest statement

The authors declare no competing interests.

© 2021. The Author(s), under exclusive licence to the International Pediatric Research Foundation, Inc.

Figures

Fig. 1. Critical care outcomes for critically…
Fig. 1. Critical care outcomes for critically ill children and young adults with confirmed and suspected SARS-CoV2 infection and by AKI status.
Percentage of patients in the given category presented on Y axis. X axis presents various clinical outcomes by cohort; suspected of SARS-CoV2 without AKI, n = 331; suspected of SARS-CoV2 with AKI; confirmed with SARS-CoV2 without AKI, n = confirmed with SARS-CoV2 with AKI, n = 74. *p-value < 0.05. **p-value < 0.01. ***p-value < 0.001. ****Length of hospitalization among survivors, but missing for 46 survivors and hospital mortality outcome missing for 34 patients. AKI acute kidney injury, ECMO extracorporeal membrane oxygenation.

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