Original Article

Analysis of risk factors for early-onset sepsis associated acute kidney injury in neonates

  • Man WANG ,
  • Luquan LI ,
  • Xiaowen LI
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  • Neonatal Diagnosis and Treatment Center of Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Rare Diseases in Infection and Immunity, Chongqing 400014, China

Received date: 2023-12-27

  Online published: 2024-06-07

Abstract

Objective The clinical data of neonates with early-onset sepsis (EOS) were analyzed in order to explore the risk factors affecting neonatal early-onset sepsis associated acute kidney injury (AKI). Methods The clinical data of EOS neonates hospitalized in the neonatal ward from January 2018 to April 2022 were retrospectively analyzed. The neonates meeting the revised KDIGO AKI diagnostic criteria were assigned to AKI group, and the neonates without AKI were assigned to NAKI group according to 1:2 matching method. The clinical data between the two groups were compared to analyze the risk factors of neonatal early-onset sepsis complicated with acute kidney injury (ESA-AKI). Results A total of 70 neonates in the AKI group and 140 in the NAKI group were included in the study. A univariate conditional logistic regression analysis revealed that older admission age, maternal hypertension during pregnancy, asphyxia, high levels of serum urea nitrogen and creatinine at admission, coexisting with moderate to severe anemia, pulmonary hemorrhage, patent ductus arteriosus, septic shock, exposure to small doses of dopamine and meropenem, and surgery were risk factors for the development of AKI. The AKI group had a higher rate of death or abandonment (P<0.05). Conclusions AKI should be closely monitored in the group of neonates with EOS who were treated with dopamine, meropenem, and surgery and who had higher admission ages, asphyxia, maternal hypertension during pregnancy, high serum urea nitrogen and creatinine levels at admission, complicated by moderate to severe anemia, pulmonary hemorrhage, patent ductus arteriosus, and septic shock.

Cite this article

Man WANG , Luquan LI , Xiaowen LI . Analysis of risk factors for early-onset sepsis associated acute kidney injury in neonates[J]. Journal of Clinical Pediatrics, 2024 , 42(6) : 520 -525 . DOI: 10.12372/jcp.2024.23e1250

References

[1] 中华医学会儿科学分会新生儿学组, 中国医师协会新生儿科医师分会感染专业委员会新生儿败血症诊断及治疗专家共识(2019年版)[J]. 中华儿科杂志, 2019, 57(4): 252-257.
[2] Flannery DD, Puopolo KM. Neonatal early-onset sepsis[J]. Neoreviews, 2022, 23(11): 756-770.
[3] Deep A, Sagar H, Goonasekera C, et al. Evolution of acute kidney injury and its association with systemic hemodynamics in children with fluid-refractory septic shock[J]. Crit Care Med, 2018, 46(7): 677-683.
[4] Fitzgerald JC, Ross ME, Thomas NJ, et al. Risk factors and inpatient outcomes associated with acute kidney injury at pediatric severe sepsis presentation[J]. Pediatr Nephrol, 2018, 33(10): 1781-1790.
[5] Ozkaya PY, Taner S, Ersayo?lu I, et al. Sepsis associated acute kidney injury in pediatric intensive care unit[J]. Ther Apher Dial, 2023, 27(1): 73-82.
[6] Zhang W, Qi R, Li T, et al. Kidney organoids as a novel platform to evaluate lipopolysaccharide-induced oxidative stress and apoptosis in acute kidney injury[J]. Front Med (Lausanne), 2021, 8: 766073.
[7] Hua T, Wu X, Wang W, et al. Micro- and macrocirculatory changes during sepsis and septic shock in a rat model[J]. Shock, 2018, 49(5): 591-595.
[8] Flannery AH, Ortiz-Soriano V, Li X, et al. Serum renin and major adverse kidney events in critically ill patients: a multicenter prospective study[J]. Crit Care, 2021, 25(1): 294.
[9] van der Slikke EC, Star BS, van Meurs M, et al. Sepsis is associated with mitochondrial DNA damage and a reduced mitochondrial mass in the kidney of patients with sepsis-AKI[J]. Crit Care, 2021, 25(1): 36.
[10] Fitzgerald JC, Ross ME, Thomas NJ, et al. Association of early hypotension in pediatric sepsis with development of new or persistent acute kidney injury[J]. Pediatr Nephrol, 2021, 36(2): 451-461.
[11] Jetton JG, Boohaker LJ, Sethi SK, et al. Incidence and outcomes of neonatal acute kidney injury (AWAKEN): a multicentre, multinational, observational cohort study[J]. Lancet Child Adolesc Health, 2017, 1(3): 184-194.
[12] Durkan AM, Alexander RT. Acute kidney injury post neonatal asphyxia[J]. J Pediatr, 2011, 158(2 Suppl): e29-e33.
[13] Saikumar P, Venkatachalam MA. Role of apoptosis in hypoxic/ischemic damage in the kidney[J]. Semin Nephrol, 2003, 23(6): 511-521.
[14] Chan EG, Pan G, Clifford S, et al. Postoperative acute kidney injury and long-term outcomes after lung transplantation[J]. Ann Thorac Surg, 2023, 116(5): 1056-1062.
[15] Kuo G, Chen JJ, Yen CL, et al. Association between early, small creatinine elevation and severe acute kidney injury in critically ill adult patients[J]. J Crit Care, 2022, 72: 154142.
[16] 潘益匆, 王大化, 郑俊虎, 等. 妊娠期高血压疾病对新生儿肾功能及脐血胆红素水平的影响[J]. 中国优生与遗传杂志, 2018, 26(11): 80-82.
[17] Yuan T, Zhang T, Han Z. Placental vascularization alterations in hypertensive disorders complicating pregnancy (HDCP) and small for gestational age with HDCP using three-dimensional power doppler in a prospective case control study[J]. BMC Pregnancy Childbirth, 2015, 15: 240.
[18] Yang Y, Xie Y, Li M, et al. Characteristics and fetal outcomes of pregnant women with hypertensive disorders in China: a 9-year national hospital-based cohort study[J]. BMC Pregnancy Childbirth, 2022, 22(1): 924.
[19] 陈子衿, 阳海平, 张高福, 等. 极低出生体质量儿急性肾损伤的危险因素及结局分析[J]. 临床儿科杂志, 2018, 36(6): 406-410.
[20] Teixeira JP, Ambruso S, Griffin BR, et al. Pulmonary consequences of acute kidney injury[J]. Semin Nephrol, 2019, 39(1): 3-16.
[21] Iribarren I, Hilario E, álvarez A, et al. Neonatal multiple organ failure after perinatal asphyxia[J]. An Pediatr (Engl Ed), 2022, 97(4): 280.
[22] Gul R, Anwar Z, Sheikh M, et al. Neonatal AKI profile using KDIGO guidelines: a cohort study in tertiary care hospital ICU of Lahore, Pakistan[J]. Front Pediatr, 2022, 10: 1040077.
[23] Majed B, Bateman DA, Uy N, et al. Patent ductus arteriosus is associated with acute kidney injury in the preterm infant[J]. Pediatr Nephrol, 2019, 34(6): 1129-1139.
[24] Stanski NL, Pode Shakked N, Zhang B, et al. Serum renin and prorenin concentrations predict severe persistent acute kidney injury and mortality in pediatric septic shock[J]. Pediatr Nephrol, 2023, 38(9): 3099-3108.
[25] Bellomo R, Forni LG, Busse LW, et al. Renin and survival in patients given angiotensin II for catecholamine-resistant vasodilatory shock. A Clinical Trial[J]. Am J Respir Crit Care Med, 2020, 202(9): 1253-1261.
[26] Tumlin JA, Murugan R, Deane AM, et al. Angiotensin II for the treatment of high-output shock 3 (ATHOS-3) investigators. outcomes in patients with vasodilatory shock and renal replacement therapy[J]. Crit Care Med, 2018, 46(6): 949-957.
[27] Zhang P, Tong Y, Yuan D, et al. Association of high-sensitivity C-reactive protein and anemia with acute kidney injury in neonates[J]. Front Pediatr, 2022, 10: 882739.
[28] 王彦娥, 丁伶清, 宋洪涛, 等. 非ICU患者肾毒性药物与急性肾损伤关系的病例对照研究[J]. 中国医院药学杂志, 2018, 38(8): 869-873.
[29] Gorham J, Taccone FS, Hites M. Drug regimens of novel antibiotics in critically ill patients with varying renal functions: a rapid review[J]. Antibiotics (Basel), 2022, 11(5): 546.
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