Abstract 14628: Acute Kidney Injury in Pediatric Acute Heart Failure
Objective: Acute kidney injury (AKI) in adult patients with acute heart failure (AHF) is associated with increased morbidity and mortality. There is limited literature in the population of pediatric patients with AHF and AKI. We aim to study AKI in the pediatric AHF population and its association with specific clinical outcomes.
Methods: The index admission of all patients ≤ 21 years of age with AHF (as defined by the Ross/NYHA heart failure classification) between January 2008 and December 2012 was retrospectively reviewed to determine whether AKI, defined by the pRIFLE criteria, was associated with cardiac transplantation and/or mortality. Patients with congenital heart disease or previously diagnosed AKI were excluded. pRIFLE score was calculated for each patient based on the percent change of estimated creatinine clearance (eCCL) from baseline during the index admission (Risk = 25% decrease; Injury = 50% decrease; Failure = 75% decrease). Descriptive statistics and univariate analyses using the chi-square test or Fisher’s exact test were performed to determine the association between AKI and a composite outcome of cardiac transplantation or mortality, respectively.
Results: Fifty-seven patients, with median age 12 years [IQR 1.1-16], were determined to have AHF during the study period of which 31 (54%) had dilated cardiomyopathy and 18 (31.5%) had myocarditis. The median Ross/NYHA heart failure classification score was 3 [IQR 2-4] and median left ventricular ejection fraction was 27% [IQR 18-48]. Twenty-one (36%) patients underwent cardiac transplantation and 5 patients (8.7%) died. Of the 57 patients, 44 (77%) had evidence of AKI (41% Risk; 39% Injury; 20% Failure). Of the 44 patients with AKI 25 (57%) met the composite outcome. AKI was significantly associated with the composite outcome (odds ratio 15.8; 95% CI 1.8, 353; p = 0.003) as compared to patients without AKI. Patients with non-myocarditis cardiomyopathy were more likely to be associated with AKI (odds ratio 8.7; 95% CI 1.8, 45; p = 0.004) as compared to patients with myocarditis.
Conclusion: AKI in pediatric AHF is common and is associated with cardiac transplantation and/or mortality. AKI was more likely to be associated with patients with non-myocarditis cardiomyopathy.
- © 2013 by American Heart Association, Inc.