Virtual pediatric systems: AKI in pediatric COVID-19 among north american intensive care units

ABSTRACT

Background: There is a dearth of large-scale studies assessing the extent of Acute Kidney Injury (AKI) in pediatric COVID-19 patients. We aim to identify the epidemiology and associated risk factors of AKI in the pediatric COVID population through the Virtual Pediatric Systems (VPS) database. Methods: We performed a retrospective analysis on 2,597 COVID-19 pediatric patients (≤ 24 years) in the VPS COVID-19 database including both males and females with a positive status of SARS-CoV-2 infection, ICU admission, and AKI diagnosis for the AKI group using ICD-10 codes. Variables included in the analyses covered demographics, diagnosis, lab order/results, treatment modalities, length of stay, and mortality. Categorical variables were summarized as percentages while continuous variables as medians. We utilized univariate analysis and multivariate linear regression to assess the differences between the patient group with AKI and those without. Results: An AKI incidence of 10.7% (297/2597) was found within the pediatric cohort. The AKI group had a significantly higher median hospital length of stay (9.1 days vs. 5.1), PIM2 and PIM3 probability of death (1.2 vs. 0.96 and 0.99 vs. 0.78, respectively), and proportion of mortality (7.5% vs. 1.6%) in comparison to the non-AKI group. Similarly, the AKI group experienced higher rates of interventions in comparison to the non-AKI group such as vascular access (67.0% vs. 29.8%), airway/respiratory support (55.9% vs. 43.8%), renal support (5.4% vs. 0.4%), and cardio-respiratory support (2.9% vs. 0.8%). Conclusions: AKI is a severe complication of COVID-19 in children and adolescents. Our study suggests a 4.7-fold increase in mortality in the COVID-19 AKI group. Pediatric COVID-19 patients should be monitored for AKI development and necessitate analyses on manifestations of COVID-19 to improve health outcomes.