New Study from UPMC Children’s Pediatric Nephrology Team Uncovers Risk of Developing Sepsis After Acute Kidney Injury in Pediatric ICU Patients

January 19, 2023

UPMC Children’s Division of Pediatric Nephrology researcher, Cassandra Lynn Formeck, MD, MS, assistant professor of Pediatrics, led a new study investigating acute kidney injury (AKI) and sepsis in pediatric ICU patients. The study is forthcoming in the journal Kidney360 published by the American Society of Nephrology.

Dr. Formeck’s research paper is titled, “Risk and Timing of De Novo Sepsis in Critically Ill Children Following Acute Kidney Injury.”

AKI is a common morbidity affecting critically ill children cared for in the intensive care unit (ICU). Among other consequences, AKI is associated with an increased risk for de novo infection, however little is known about the epidemiology and temporal relationship between AKI and AKI-associated infection in these patients.

Study Overview

Dr. Formeck’s team conducted a single-center retrospective cohort study of children admitted to the pediatric and cardiac ICUs at UPMC Children’s between 2010 and 2014. The study included data from 5,695 cases.

They found that any grade of AKI occurred in 20.2% of patients, a data point that continues to support the existence of high rates of AKI in ICU patients. Furthermore, 10.1% of patients who had an AKI also developed hospital-acquired sepsis, compared to only 4.6% of ICU patients who did not experience an AKI – more than double the rate.

Dr. Formeck and the team also learned that in those patients who developed AKI and subsequently sepsis, 80.3% of consequent sepsis cases occurred within 7 days of AKI onset, while 96.6% occurred within 14 days. The median time to developing sepsis after AKI was 2.6 days.

Other significant clinical highlights and findings from the investigation include:

  • Critically ill children who develop an AKI have a 42% increase in the probability of developing hospital-acquired sepsis vs children who do not suffer an AKI.

  • When evaluating the risk of developing sepsis over time, children experiencing a stage 3 AKI remain at increased risk for sepsis for at least two weeks after the onset of the AKI.

“The goal of this study was to better characterize the temporal features of AKI-associated immune dysfunction among critically ill children,“ says Dr. Formeck. “After adjusting for other known risk factors for hospital-acquired infection, we found that hospital-acquired sepsis occurred twice as often among children with AKI compared to those without AKI, and that the risk for sepsis remained elevated for at least two weeks in children with severe AKI. Importantly, in two-thirds of children with AKI, the heightened risk for sepsis persisted beyond normalization of their kidney function. This suggests that AKI-associated immune dysfunction is not simply a result of decreased renal clearance, but due to a more complex interaction between the kidneys and the immune system.”

Providers Must Be Vigilant

The findings from this study can be immediately useful for intensive care providers and pediatric nephrologists alike. Pediatric ICU patients should be closely monitored for signs of sepsis following diagnosis of AKI and limit exposures that may increase the risk of infection.


Formeck CL, Feldman R, Althouse AD, Kellum JA. Risk and Timing of De Novo Sepsis in Critically Ill Children Following Acute Kidney Injury. Kidney360. December 18, 2022: 10.34067/KID.0005082022. Ahead of print.