Blood transfusion in pediatric sepsis-associated acute kidney injury: a nationwide study of risk factors and outcomes.

[BACKGROUND] Sepsis-associated acute kidney injury (SA-AKI) is a severe pediatric condition often requiring red blood cell transfusion, yet its transfusion risk factors remain unclear. This study investigated the incidence, temporal trends, and determinants of transfusion in children with SA-AKI.

[METHODS] Using the U.S. Nationwide Inpatient Sample (2010-2019), pediatric patients (< 18 years) with SA-AKI were identified by ICD-9/10 codes. Demographic, hospital, comorbidity, and complication data were compared and then analyzed using multivariate logistic regression to identify independent risk factors for transfusion.

[RESULTS] Among 7,521 children with SA-AKI, 30.17% received transfusions. The annual transfusion rate declined from 45.6% (2010) to 21.6% (2019). Independent risk factors included younger age, Black/Hispanic/Asian race, higher comorbidity burden, teaching hospital admission, elective admission, and Northeast hospital location. Specific comorbidities (coagulopathy, disseminated intravascular coagulation, lymphoma, fluid/electrolyte disorders, neurological disorders, and solid tumor without metastasis) and complications (continuous trauma ventilation, acute respiratory failure, gastrointestinal bleeding, thrombocytopenia, septic shock, hepatic insufficiency) significantly increased transfusion likelihood. Protective factors included chronic pulmonary disease, uncomplicated diabetes, paralysis, and urinary tract infection.

[CONCLUSION] Pediatric SA-AKI transfusion rates have markedly decreased over the past decade. Risk factors reflect disease severity and acute complications, while certain chronic conditions appear protective. These findings highlight the complexity of transfusion decision-making in SA-AKI and may inform strategies to optimize transfusion practices.