Prevalence of Acute Kidney Injury and Its Association With Outcomes in Children With Severe Traumatic Brain Injury: A Secondary Exploratory Analysis of the 2014–2017 “Approaches and Decisions for Acute Pediatric Traumatic Brain Injury” Study
Ryan L. DeSanti, Mohamed Almuqamam, Mona Faramawy, Anna M. Janas, Tara M. Neumayr, Dana Y. Fuhrman, Ayse Akcan-Arikan, Michael J. BellOBJECTIVES:
Patients with severe traumatic brain injury (TBI) are at risk of developing nonneurologic organ dysfunction. Acute kidney injury (AKI) has been associated with morbidity and mortality in adults with TBI, but the prevalence in children is poorly described. The objective of this study was to determine the prevalence of AKI among a multiinstitutional, international cohort of children with severe TBI and to explore the association of AKI with outcomes.
DESIGN:
An unplanned, secondary exploratory analysis of the Approaches and Decisions for Acute Pediatric TBI (ADAPT) study.
SETTING:
Fifty-one institutions participating in ADAPT.
PATIENTS:
Children with severe TBI who underwent intracranial pressure monitoring and were admitted to a participating institution from 2014 to 2017.
INTERVENTIONS:
None.
MEASUREMENTS AND MAIN RESULTS:
AKI was considered to have occurred when a patient met either the ADAPT definition of AKI or the Kidney Disease: Improving Global Outcomes (KDIGO) AKI criteria. The daily urine output and worst creatinine within the first 12 hours of admission were reviewed to determine who met KDIGO criteria. One thousand children were included and 160 children (16%) had AKI. Of these, stage 1 AKI occurred in 78 of 160 patients (48%), stage 2 in 65 of 160 patients (41%), and stage 3 AKI in 17 of 160 patients (11%). After adjusting for covariates in regression analyses, AKI was associated with an increase in hospital length of stay (LOS) and a worse Glasgow Outcome Scale Extended-Pediatrics score, but we failed to identify an association with longer PICU LOS or prevalence of mortality.
CONCLUSIONS:
In the ADAPT cohort, AKI was present in 16% of cases. Although we found an association between AKI and two clinically important secondary outcomes, more contemporary studies are needed to better characterize AKI in children with severe TBI and to determine whether strategies aimed at preventing AKI can improve patient-centered outcomes.