tetano
Editor, Senior Moderator
J Trop Pediatr
. 2021 May 17;67(2):fmab037.
doi: 10.1093/tropej/fmab037.
Acute Kidney Injury in Hospitalized Children with COVID19
Sanya Chopra[SUP] 1 [/SUP], Abhijeet Saha[SUP] 2 [/SUP], Virendra Kumar[SUP] 1 [/SUP], Archana Thakur[SUP] 1 [/SUP], Harish Pemde[SUP] 1 [/SUP], Dipti Kapoor[SUP] 1 [/SUP], Sandip Ray[SUP] 1 [/SUP], Aditi Das[SUP] 1 [/SUP], Kaveri Pandit[SUP] 1 [/SUP], Anu Gulati[SUP] 1 [/SUP], Ankita Goel Sharma[SUP] 1 [/SUP], Preeti Singh[SUP] 1 [/SUP], Ravitanya Sodani[SUP] 1 [/SUP]
Affiliations
Abstract
Background: Acute kidney injury (AKI) has been recognized as a significant risk factor for mortality among adults with severe acute respiratory syndrome coronavirus infection.
Aim: The aim of this study is to assess the prevalence and risk factors for AKI and mortality in children with coronavirus disease 2019 (COVID19) from a resource-limited setting.
Methods: Cross-sectional analysis of laboratory confirmed COVID19 children admitted from 1 March to 30 November 2020 in a tertiary care hospital in New Delhi, India was done. Clinical features and associated comorbidities of COVID19 were noted. Baseline serum creatinine (height-independent Hoste's equation) and peak serum creatinine were used for staging of AKI by the 2012 Kidney Disease Improving Global Outcomes serum creatinine criteria. Univariate analysis and Kaplan-Meier survival analysis were used to compare the overall outcome in the AKI vs. the non-AKI group.
Results: A total of 64 810 children between 1 month and 18 years visited the hospital; 3412 were tested for suspected COVID19, 295 tested positive and 105 (54% boys) were hospitalized. Twenty-four hospitalized children (22.8%) developed AKI; 8 in Stage 1 (33.3%), 7 in Stage 2 (29.2%) and 9 in Stage 3 (37.5%) respectively. Overall, three patients received KRT. Highest reported mortality was (66.6%) in AKI Stage 3. Risk factors for AKI included associated sepsis (OR 95% CI, 1.22-9.43, p < 0.01), nephrotic syndrome (OR 95% CI, 1.13-115.5, p < 0.01), vasopressor support (OR 3.59, 95% CI, 1.37-9.40, p value< 0.007), shock at presentation (OR 2.98, 95% CI, 1.16-7.60, p value 0.01) and mechanical ventilation (OR 2.64, 95% CI, 1.04-6.71, p value< 0.03). Mortality (25.71%) was higher in the AKI group (OR 95% CI, 1.14-8.35, p < 0.023) with shock (OR 45.92; 95% CI, 3.44-612.0, p value <0.004) and ventilation (OR 46.24; 95% CI, 1.6-1333.0 p value< 0.02) as significant risk factors for mortality.
Conclusion: AKI is an important modifiable risk factor for mortality in children with COVID19 in a resource-limited setting. Our study supports the strengthening of kidney replacement therapy and its timely initiation to reduce the progression of AKI and thus mortality in children.
Keywords: acute kidney injury; coronavirus disease 19; resource-limited setting; sepsis.
. 2021 May 17;67(2):fmab037.
doi: 10.1093/tropej/fmab037.
Acute Kidney Injury in Hospitalized Children with COVID19
Sanya Chopra[SUP] 1 [/SUP], Abhijeet Saha[SUP] 2 [/SUP], Virendra Kumar[SUP] 1 [/SUP], Archana Thakur[SUP] 1 [/SUP], Harish Pemde[SUP] 1 [/SUP], Dipti Kapoor[SUP] 1 [/SUP], Sandip Ray[SUP] 1 [/SUP], Aditi Das[SUP] 1 [/SUP], Kaveri Pandit[SUP] 1 [/SUP], Anu Gulati[SUP] 1 [/SUP], Ankita Goel Sharma[SUP] 1 [/SUP], Preeti Singh[SUP] 1 [/SUP], Ravitanya Sodani[SUP] 1 [/SUP]
Affiliations
- PMID: 34080011
- DOI: 10.1093/tropej/fmab037
Abstract
Background: Acute kidney injury (AKI) has been recognized as a significant risk factor for mortality among adults with severe acute respiratory syndrome coronavirus infection.
Aim: The aim of this study is to assess the prevalence and risk factors for AKI and mortality in children with coronavirus disease 2019 (COVID19) from a resource-limited setting.
Methods: Cross-sectional analysis of laboratory confirmed COVID19 children admitted from 1 March to 30 November 2020 in a tertiary care hospital in New Delhi, India was done. Clinical features and associated comorbidities of COVID19 were noted. Baseline serum creatinine (height-independent Hoste's equation) and peak serum creatinine were used for staging of AKI by the 2012 Kidney Disease Improving Global Outcomes serum creatinine criteria. Univariate analysis and Kaplan-Meier survival analysis were used to compare the overall outcome in the AKI vs. the non-AKI group.
Results: A total of 64 810 children between 1 month and 18 years visited the hospital; 3412 were tested for suspected COVID19, 295 tested positive and 105 (54% boys) were hospitalized. Twenty-four hospitalized children (22.8%) developed AKI; 8 in Stage 1 (33.3%), 7 in Stage 2 (29.2%) and 9 in Stage 3 (37.5%) respectively. Overall, three patients received KRT. Highest reported mortality was (66.6%) in AKI Stage 3. Risk factors for AKI included associated sepsis (OR 95% CI, 1.22-9.43, p < 0.01), nephrotic syndrome (OR 95% CI, 1.13-115.5, p < 0.01), vasopressor support (OR 3.59, 95% CI, 1.37-9.40, p value< 0.007), shock at presentation (OR 2.98, 95% CI, 1.16-7.60, p value 0.01) and mechanical ventilation (OR 2.64, 95% CI, 1.04-6.71, p value< 0.03). Mortality (25.71%) was higher in the AKI group (OR 95% CI, 1.14-8.35, p < 0.023) with shock (OR 45.92; 95% CI, 3.44-612.0, p value <0.004) and ventilation (OR 46.24; 95% CI, 1.6-1333.0 p value< 0.02) as significant risk factors for mortality.
Conclusion: AKI is an important modifiable risk factor for mortality in children with COVID19 in a resource-limited setting. Our study supports the strengthening of kidney replacement therapy and its timely initiation to reduce the progression of AKI and thus mortality in children.
Keywords: acute kidney injury; coronavirus disease 19; resource-limited setting; sepsis.