Grace Fisler, MD
Fellow, Pediatric Critical Care
Cohen Children's Medical Center
New Hyde Park, NY
Disclosure information not submitted.
Daniel Leisman, MD, MSCR
Resident Physician, PGY-2
Massachusetts General Hospital
Boston, Massachusetts
Disclosure information not submitted.
Kristina Murphy, DO
Attending Physician
Cohen Children's Medical Center
New Hyde Park, New York, United States
Disclosure information not submitted.
Fiore Mastroianni, MD, MS
Fellow
Zucker School of Medicine at Hofstra/Northwell
New Hyde Park, New York
Disclosure information not submitted.
Andrea La Bella, n/a
Clinical Research Assistant
Cohen Children's Medical Center, United States
Disclosure information not submitted.
James Schneider, MD
Associate Professor
Cohen Children's Medical Center, United States
Disclosure information not submitted.
Matthew Taylor, MD
Pediatric Critical Care Attending Physician
Cohen Children's Medical Center
New Hyde Park, New York, United States
Disclosure information not submitted.
Title: Renal Blood Flow by POCUS Correlates with Altered Renal Function and is Abnormal in Pediatric Sepsis
Introduction: Up to one-third of PICU patients develop acute kidney injury (AKI); sepsis is a leading etiology. We aimed to determine (1) if point-of-care ultrasound (POCUS) measurements of renal blood flow (RBF) correlate with alterations in creatinine (Cr) and urine output (UOP) and (2) if sepsis alters RBF. Power doppler (PDU), which quantifies blood flow regardless of directionality (higher score = more blood flow), and renal resistive index (RRI), which reflects regional vascular resistance (normal RRI < 0.70), were used to measure RBF.
Methods: This is an interim analysis of an ongoing prospective observational cohort study; enrollment began July 2020. Pediatric patients admitted to a tertiary PICU were approached for enrollment within 48hrs of admission if they required fluid resuscitation or vasoactive support. Acute organ dysfunction (aOD) was defined as pSOFA >=2 above baseline and sepsis as infection with aOD. Renal POCUS was performed on study days 1, 3, and 7. PDU was scored by a blinded reader. RRI, PDU scores, clinical and laboratory data were recorded. Baseline Cr was collected; if unavailable, a normal GFR was assumed, and baseline Cr was calculated with the revised Schwartz equation.
Results: To date, 40 patients have been enrolled (mean age 10.5yrs, 77% male). Patients were categorized as sepsis (n=22), aOD without infection (n=12), and infection without aOD (n=6). Infection without aOD were not analyzed due to sample size at interim analysis.
In the 34 patients with aOD, multivariate linear regression analysis demonstrated that an elevated day 1 RRI correlated with higher day 1 Cr (p=0.01) and lower 6hr UOP (p=0.03), after adjusting for baseline Cr. After adjusting for baseline Cr, lower day 1 PDU correlated with higher day 1 Cr (p=0.003) and lower 6hr UOP (p=0.04). The sepsis cohort had higher day 1 RRI than uninfected aOD (mean 0.77 vs 0.63, p< 0.001). No difference was noted in sepsis and uninfected aOD day 1 PDU scores (mean 1.7 vs 2.3, p=0.10).
Conclusions: In this interim analysis, RBF measured by renal POCUS correlated with initial Cr and 6hr UOP in children with aOD. Further, septic children had increased RRI compared to non-infected children with aOD. Future analysis aims to correlate POCUS measurements with AKI stage and future development of AKI.