OBJECTIVE To determine how hypotension in the first 48 h of sepsis management impacts acute kidney injury (AKI) development and persistence. STUDY DESIGN Retrospective study of patients > 1 month to < 20 years old with sepsis in a pediatric ICU between November 2012 and January 2015 (n = 217). All systolic blood pressure (SBP) data documented within 48 h after sepsis recognition were collected and converted to percentiles for age, sex, and height. Time below SBP percentiles and below pediatric advanced life support (PALS) targets was calculated by summing elapsed time under SBP thresholds during the first 48 h. The primary outcome was new or persistent AKI, defined as stage 2 or 3 AKI present between sepsis day 3-7 using Kidney Disease: Improving Global Outcomes creatinine definitions. Secondary outcomes included AKI-free days (days alive and free of AKI) and time to kidney recovery. RESULTS Fifty of 217 sepsis patients (23%) had new or persistent AKI. Patients with AKI spent a median of 35 min under the first SBP percentile, versus 4 min in those without AKI. After adjustment for potential confounders, the odds of AKI increased by 9% with each doubling of minutes spent under this threshold (p = 0.03). Time under the first SBP percentile was also associated with fewer AKI-free days (p = 0.02). Time spent under PALS targets was not associated with AKI. CONCLUSIONS The duration of severe systolic hypotension in the first 48 h of pediatric sepsis management is associated with AKI incidence and duration when defined by age, sex, and height norms, but not by PALS definitions. Graphical abstract.

中文翻译：

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小儿脓毒症早期低血压与新发或持续性急性肾损伤的关系。

目的 确定脓毒症治疗前 48 小时内的低血压如何影响急性肾损伤 (AKI) 的发展和持续。研究设计 对 2012 年 11 月至 2015 年 1 月期间儿科 ICU 中 > 1 个月至 < 20 岁的脓毒症患者进行回顾性研究 (n = 217)。收集败血症识别后 48 小时内记录的所有收缩压 (SBP) 数据，并将其转换为年龄、性别和身高的百分位数。低于 SBP 百分位数和低于儿科高级生命支持 (PALS) 目标的时间是通过对前 48 小时内 SBP 阈值以下经过的时间求和来计算的。主要结局是新发或持续性 AKI，定义为脓毒症第 3-7 天之间出现的 2 期或 3 期 AKI，使用《肾脏疾病：改善全球结局》肌酐定义。次要结局包括无 AKI 天数（存活且无 AKI 的天数）和肾脏恢复时间。结果 217 名脓毒症患者中有 50 名 (23%) 患有新发或持续性 AKI。患有 AKI 的患者在第一个 SBP 百分位数以下的时间中位数为 35 分钟，而没有 AKI 的患者为 4 分钟。对潜在混杂因素进行调整后，在此阈值下花费的分钟数每增加一倍，AKI 的几率就会增加 9% (p = 0.03)。低于第一个 SBP 百分位数的时间也与较少的无 AKI 天数相关 (p = 0.02)。达到 PALS 目标的时间与 AKI 无关。结论 当根据年龄、性别和身高标准定义时，儿科脓毒症治疗前 48 小时内严重收缩性低血压的持续时间与 AKI 发生率和持续时间相关，但与 PALS 定义无关。图形概要。