Risk factors for in-hospital mortality and acute kidney injury in neonatal-pediatric patients receiving extracorporeal membrane oxygenation

Min-Tser Liao; I-Jung Tsai; Fu-Huang Lin; Li-Jung Tseng; Shu-Chien Huang; Yih-Sharng Chen; En-Ting Wu; Yong-Kwei Tsau; National Taiwan University Hospital Study Group on Acute Renal Failure (NSARF)

doi:10.1016/j.jfma.2021.03.004

Risk factors for in-hospital mortality and acute kidney injury in neonatal-pediatric patients receiving extracorporeal membrane oxygenation

J Formos Med Assoc. 2021 Sep;120(9):1758-1767. doi: 10.1016/j.jfma.2021.03.004. Epub 2021 Mar 31.

Authors

Min-Tser Liao¹, I-Jung Tsai², Fu-Huang Lin³, Li-Jung Tseng⁴, Shu-Chien Huang⁴, Yih-Sharng Chen⁴, En-Ting Wu⁵, Yong-Kwei Tsau⁶; National Taiwan University Hospital Study Group on Acute Renal Failure (NSARF)

Affiliations

¹ Department of Pediatrics, Taoyuan Armed Forces General Hospital, Taoyuan, 325, Taiwan; Department of Pediatrics, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
² Division of Nephrology, Department of Pediatrics, National Taiwan University Children's Hospital, Taipei, Taiwan. Electronic address: ijtsai@ntu.edu.tw.
³ School of Public Health, National Defense Medical Center, Taipei, Taiwan.
⁴ Department of Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
⁵ Department of Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan; Division of Critical Care, Department of Pediatrics, National Taiwan University Children's Hospital, Taipei, Taiwan. Electronic address: entingwu@ntu.edu.tw.
⁶ Division of Nephrology, Department of Pediatrics, National Taiwan University Children's Hospital, Taipei, Taiwan.

PMID: 33810928
DOI: 10.1016/j.jfma.2021.03.004

Abstract

Background: Acute kidney injury (AKI) is the most frequent complication in critically ill neonatal and pediatric patients receiving extracorporeal membrane oxygenation (ECMO) support. This study analyzed risk factors for in-hospital mortality and the incidence of AKI in neonatal and pediatric patients received ECMO support.

Methods: We reviewed the medical records of 105 neonatal and 171 pediatric patients who received ECMO support at the intensive care unit (ICU) of a tertiary care university hospital between January 2008 and December 2015. Demographic, clinical, and laboratory data were retrospectively collected as survival and AKI predictors, utilizing the Kidney Disease Improving Global Outcome (KDIGO) consensus definition for AKI.

Results: In the 105 neonatal and 171 pediatric patients, the overall in-hospital mortality rate were 58% and 55% respectively. The incidence of AKI at post-ECMO 24 h were 64.8% and 61.4%. A greater KDIGO_24-h severity was associated with a higher in-hospital mortality rate (chi-square test; p < 0.01) and decreased survival rate (log-rank tests, p < 0.01). In univariate logistic regression analysis of in-hospital mortality, the CVP level at post ECOMO 24-h increased odds ratio (OR) (OR = 1.27 [1.10-1.46], p = 0.001) of in-hospital mortality in neonatal group; as for pediatric group, elevated lactate (OR = 1.12 [1.03-1.20], p = 0.005) and PT (OR = 1.86 [1.17-2.96], p = 0.009) increased OR of in-hospital mortality. And the KDIGO_24h stage 3 had the strongest association with in-hospital mortality in both neonatal (p = 0.005) and pediatric (p = 0.001) groups. In multivariate OR of neonatal and pediatric groups were 4.38 [1.46-13.16] (p = 0.009) and 3.76 [1.70-8.33] (p = 0.001), respectively.

Conclusion: AKI was a significant risk factor for in-hospital mortality in the neonatal and pediatric patients who received ECMO support. A greater KDIGO24-h severity was associated with higher mortality rates and decreased survival rate in both neonatal and pediatric groups. Of note, KDIGO24h can be an easy and early tool for the prognosis of AKI in the neonatal and pediatric patients.

Keywords: Acute kidney injury; Extracorporeal membrane oxygenation; KDIGO.

MeSH terms

Acute Kidney Injury* / epidemiology
Acute Kidney Injury* / therapy
Child
Extracorporeal Membrane Oxygenation* / adverse effects
Hospital Mortality
Humans
Retrospective Studies
Risk Factors