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Fluid overload and kidney failure in children with severe sepsis and septic shock: A cohort study

2017; Sociedad Argentina de Pediatría; Volume: 115; Issue: 2 Linguagem: Inglês

10.5546/aap.2017.eng.118

1668-3501

Omar Eugenio Naveda Romero, Andrea Fabiola Naveda Meléndez,

Sepsis Diagnosis and Treatment

In children with sepsis, fluid overload as a result of an aggressive fluid replacement or excessive fluid administration may result in kidney impairment and increased mortality.Objective. To determine the association between fluid overload and the rate of kidney failure in a group of children with severe sepsis and septic shock.This was a prospective cohort study conducted in the intensive care unit of Hospital Universitario de Pediatría “Dr. Agustín Zubillaga” (Barquisimeto, Lara State, Venezuela), between March 2013 and May 2016, in children with severe sepsis or septic shock.One hundred and forty-nine patients were included in the analysis. Sepsis predominated in 59.7% of cases; patients' average age was 6.4 ± 3.3 years old, their average weight was 17.8 ± 3.6 kg, 30.2% had fluid overload, and overall mortality was 25.5%. Kidney failure occurred in 16.1% of cases. A binary logistic regression model was used to identify fluid overload (odds ratio [OR]: 1.5; 95% confidence interval [CI]: 1.2-4.9, p = 0.028) and shock for more than 2 days (OR: 1.7; 95% CI: 1.3-6.3, p = 0.039) as independent predictors of kidney failure. In addition, a significant increase in the risk of mortality among children with kidney failure and fluid overload was observed as per the Kaplan-Meier method (p= 0.019).Fluid overload and shock for more than 2 days increase the risk for kidney failure in critically ill children with severe sepsis and septic shock.En niños con sepsis, la sobrecarga hídrica como resultado de una terapia de resucitación agresiva o por la administración excesiva de fluidos puede afectar la función renal y aumentar la mortalidad.