Acute kidney diseases and disorders in children with bloodstream infection: frequency, predictors, and outcomes

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Data on AKD after bloodstream infection are limited. Methods This single-center, retrospective observational study included patients aged < 20 years with BSI who were subsequently diagnosed with acute kidney injury (AKI) and/or AKD between 1 May 2013 and 31 May 2023. The index day was the date of the first positive blood culture. AKI (days 0–7) and AKD (days 7–90) were defined according to the Kidney Disease: Improving Global Outcomes/Acute Disease Quality Initiative criteria. Patients were categorized as those with AKI without AKD, AKD with AKI, and AKD without AKI. Primary comparisons included AKD (with/without AKI) versus AKI without AKD. Logistic regression analyses were conducted to identify predictors of AKD. Results Among 1427 patients with positive blood cultures, 197 developed kidney dysfunction. The final cohort comprised 96 patients, including 41 patients (43%) who developed AKD. In the final cohort, 55 patients had AKI without AKD, 33 patients had AKD with AKI, and 8 patients had AKD without AKI. By multivariable logistic regression analysis, younger age (odds ratio, 0.91; 95% confidence interval, 0.84–0.99; P = 0.046) was independently associated with AKD after adjusting for intensive care unit onset, glycopeptide exposure, and white blood cell count. Compared with AKI without AKD (0/55), those with AKD (with/without AKI) had higher rates of death (6/41, 15%) and major adverse kidney events at days 30 (7/41, 17%) and 90 (8/41, 20%). All adverse outcomes occurred in the AKD with AKI subgroup. Conclusion In children with bloodstream infection-associated kidney dysfunction, AKD occurred in a substantial proportion, including those not meeting the AKI criteria. Younger age was associated with AKD development. acute kidney injury acute kidney disease bacteremia pediatric sepsis Figures Figure 1 Introduction Acute kidney diseases and disorders (AKD) are a recently established set of criteria defined as acute or subacute kidney dysfunction that persists for 7–90 days after an initiating event [ 1 ]. AKD extends the acute kidney injury (AKI) framework by focusing on kidney dysfunction during recovery and transition, thereby aiding in identifying patients at risk of progression to chronic kidney disease (CKD). Importantly, AKD can also capture clinically meaningful kidney dysfunction that does not fulfill the conventional AKI criteria but persists within the AKD time window [ 2 ]. Bloodstream infection (BSI), a common presentation in hospitalized children, is associated with an increased risk of AKI, particularly in critically ill patients [ 3 ]. Severe BSI can predispose adult patients to subsequent AKD [ 4 , 5 ]. However, evidence on BSI-associated AKD in children, including frequency, clinical predictors, and outcomes, remains limited. Given that risk profiles and clinical trajectories vary across patient populations, risk stratification tools tailored to specific clinical settings are needed [ 6 ]. Therefore, we aimed to evaluate the frequency of AKD among children with BSI-associated kidney dysfunction (AKI and/or AKD) and to identify clinical predictors of AKD development. Our primary objective was to identify predictors of BSI-associated AKD; secondary objectives included kidney outcomes and mortality. Our findings should enable stratification of patients at high risk of AKD, thereby promoting early intervention and appropriate management. Materials and Methods Study design, site, and participants This single-center, retrospective, observational study included patients aged < 20 years who presented with BSI-associated kidney dysfunction between 1 May 2013 and 31 May 2023. Patients with the diagnosis of BSI with subsequent kidney injury (AKI or AKD) during the same infectious episode were included. Conversely, neonates, patients with stage 3–5 CKD before the index infection, those who underwent kidney replacement therapy (KRT) for causes other than kidney failure, and those who did not undergo follow-up evaluation for serum creatinine (SCr) levels to adjudicate AKI/AKD status were excluded. Additionally, in patients who experienced multiple episodes of BSI-associated kidney dysfunction during the study period, only the first episode was included in study analyses. Given that AKD is defined by kidney dysfunction persisting beyond day 7 of onset, patients who died within 7 days of the index day were not evaluated for AKD and were excluded from AKD analysis. Data collection Anonymized data were extracted using the hospital patient management system. The following data were collected from medical records to determine patients’ clinical course: sex, age, body weight, primary disease, place of onset, source of infection, causative pathogen, blood tests, antibiotic, infectious disease consultation, number of SCr measurements on days 0–7, sepsis, septic shock, AKI grade, time from positive blood culture to the onset of kidney injury, duration of kidney injury, and kidney and life outcomes. Study outcomes Primary endpoint was the frequency of AKD among children with BSI-associated kidney injury. Secondary endpoints were kidney outcomes (KRT requirement, CKD, and major adverse kidney events at days 30 and 90 [MAKE30 and MAKE90, respectively]), and mortality. We also evaluated clinical predictors of AKD development. Definitions The index day, i.e., day 0, was defined as the date of first positive blood culture during the index infectious episode. AKI was assessed during days 0–7, and AKD was assessed during days 7–90 after the index infectious episode. BSI was defined as the isolation of clinically significant microorganisms from blood cultures. Commensal organisms recovered from a single blood culture set were regarded as contaminants. AKI was defined according to the Kidney Disease: Improving Global Outcomes (KDIGO) criteria [ 7 ]. AKD was defined as kidney dysfunction persisting between days 7 and 90 after the index day, according to the KDIGO/Acute Disease Quality Initiative criteria [ 1 , 7 , 8 ]. Due to the retrospective study design, data on urine output were available in only 12 patients; therefore, AKI and AKD adjudication and staging were primarily based on SCr levels. AKD may occur with or without meeting the AKI criteria during the first 7 days [ 1 , 8 ]. Therefore, we identified and described cases of AKD without AKI, defined as kidney dysfunction meeting AKD criteria during days 7–90 without meeting AKI criteria during days 0–7. CKD was defined as an estimated glomerular filtration rate of < 60 mL/min/1.73 m 2 persisting for at least 3 months [ 9 ]. The reference, i.e., baseline, SCr levels were hierarchically defined. When available, the most recent SCr value obtained prior to the index day was used. In cases without available preindex SCr levels, reference SCr levels were imputed using age- and sex-specific normative values for Japanese children [ 10 ]. Estimated glomerular filtration rate was calculated using the creatinine-based equation developed for Japanese children with CKD [ 11 ]. MAKE30 and MAKE90 were defined as composite outcomes of mortality, dialysis dependence, or CKD at days 30 and 90 after the index day, respectively [ 12 ]. Sepsis was defined according to the Goldstein pediatric consensus criteria [ 13 ], and septic shock was defined as sepsis with cardiovascular dysfunction [ 13 ]. Statistical analysis All statistical analyses were performed using JMP Pro 16 (SAS Institute Japan, Tokyo, Japan). Values were expressed as medians with interquartile ranges for continuous variables and percentages for categorical variables. For descriptive purposes, patients were categorized into three groups: AKI without AKD, AKD with AKI, and AKD without AKI. For primary comparative analyses, patients were dichotomized as those with AKD (with or without AKI) versus those with AKI without AKD. Continuous variables were compared using the Mann–Whitney U test, whereas categorical variables were compared using Fisher’s exact or the chi-square test. Logistic regression was employed to evaluate predictors of AKD development. Covariates were selected a priori based on clinical relevance and to avoid overfitting, given the number of events. First, univariable logistic regression was used to assess each covariate. Variables with P values of < 0.15 in univariable analyses, as well as clinically important factors, were entered into a multivariable logistic regression model to identify independent predictors of AKD development. In an additional multivariable regression model focused on the AKD with AKI phenotype, analyses were restricted to patients with AKD with AKI and those with AKI without AKD, by excluding those with AKD without AKI. A two-sided P-value of < 0.05 was considered to indicate statistical significance. Ethics The study was approved by the Institutional Ethics Committee of the National Center for Child Health and Development (approval no. 2023 − 298) and conducted in accordance with the principles of the Declaration of Helsinki and the Ethical Guidelines for Medical and Health Research Involving Human Subjects of the Ministry of Health, Labor, and Welfare, Japan. Informed consent was waived due to the retrospective study design. Results Patient characteristics During the study period, 1427 patients had positive blood cultures. After excluding 1195 patients without AKI or AKD and 35 cases with contaminated blood cultures, the remaining 197 patients (14.1%) comprised the cohort of patients with BSI-associated kidney dysfunction. The final analysis included 96 patients, after excluding 70 neonates, 18 patients with stage 3–5 CKD before the index infection, 6 patients who underwent KRT for causes other than kidney disease, 6 patients who did not undergo SCr follow-up, and 1 patient with a subsequent BSI-associated kidney dysfunction episode (Fig. 1 ). In the final cohort, no patients died within the first 7 days of the index day. Table 1 summarizes the patient characteristics across the three groups: AKI without AKD (n = 55), AKD with AKI (n = 33), and AKD without AKI (n = 8). The analyses included three comparisons: (i) AKD (with or without AKI; n = 41) versus AKI without AKD (n = 55), (ii) AKD with AKI (n = 33) versus AKI without AKD (n = 55), and (iii) AKD with AKI (n = 33) versus AKD without AKI (n = 8). Patients with AKD were younger and had lower body weight than those with AKI without AKD. The interval from the first positive blood culture to kidney injury onset and the duration of kidney injury were longer in the AKD group. Other baseline characteristics were similar between groups. In subgroup analysis comparing the patients with AKD with AKI and those with AKD without AKD, Gram-positive cocci infections and glycopeptide use tended to be more frequent and the C-reactive protein levels were significantly lower in patients with AKD without AKI than in those with AKD with AKI. Table 1 Patient characteristics and comparison between patients with and without AKD Total (n = 96) AKI without AKD (n = 55) AKD (n = 41) P- value a P- value b P- value c AKD with AKI (n = 33) AKD without AKI (n = 8) Male 72 (75) 41 (75) 26 (79) 5 (63) 1.00 0.80 0.38 Age (years) 5.0 [1.0-10.7] 6.6 [1.9–11.7] 3.8 [0.5–9.1] 3.7 [0.9–6.5] 0.025 0.046 0.90 Body weight (kg) 14.2 [7.7–28.7] 17 [9.2–33.0] 12.4 [5.0-24.6] 10.2 [7.9–21.7] 0.030 0.052 0.86 Primary disease Respiratory 8 (8) 3 (5) 4 (12) 1 (13) 0.28 0.42 1.00 Cardiovascular 20 (21) 8 (15) 8 (24) 4 (50) 0.13 0.27 0.20 Neurological 16 (17) 10 (18) 5 (15) 1 (13) 0.78 0.78 1.00 Gastrointestinal 39 (41) 23 (42) 11 (33) 5 (63) 0.84 0.50 0.22 Hemato-0ncology 20 (21) 12 (22) 7 (21) 1 (13) 1.00 1.00 1.00 Kidney 6 (6) 2 (4) 4 (12) 0 (0) 0.40 0.19 0.57 Place of onset 0.21 0.27 0.72 Home 25 (26) 17 (31) 7 (21) 1 (13) General hospital 46 (48) 28 (51) 14 (42) 4 (50) ICU 22 (23) 9 (16) 10 (30) 3 (38) NICU 3 (3) 1 (2) 2 (6) 0 (0) Source of infection 0.25 0.27 0.47 CRBSI 34 (35) 19 (35) 12 (36) 3 (38) UTI 10 (10) 4 (7) 6 (18) 0 (0) Acute cholangitis 8 (8) 7 (13) 1 (3) 0 (0) Others 32 (33) 17 (31) 11 (33) 4 (50) Unknown 12 (13) 8 (15) 3 (9) 1 (13) Pathogen 0.75 0.74 0.07 GPC 46 (48) 24 (44) 16 (48) 6 (75) GPR 2 (2) 1 (2) 1 (3) 0 (0) GNC 0 (0) 0 (0) 0 (0) 0 (0) GNR 46 (48) 29 (53) 16 (48) 1 (13) fungi 2 (2) 1 (2) 0 (0) 1 (13) Blood tests White blood cell (/µL) 10,425 [5,537 − 15,892] 11,120 [5,430 − 19,180] 10,460 [6,490 − 16,000] 6,805 [4,530-9,738] 0.31 0.62 0.14 Hemoglobin (g/dL) 10.6 [8.8–12.2] 10.6 [8.6–12.6] 10.4 [8.6–11.9] 11.5 [10.1–13.9] 0.83 0.77 0.13 Albumin (g/dL) 3.2 [2.7–3.8] 3.2 [2.7–3.9] 2.9 [2.5–3.4] 3.7 [2.5–4.1] 0.20 0.09 0.12 C-reactive protein (mg/dL) 5.1 [1.3–11.7] 4.4 [1.3–12.1] 6.4 [2.5–12.7] 0.8 [0.3–4.5] 0.92 0.32 0.005 Sepsis 55 (57) 35 (64) 18 (55) 2 (25) 0.21 0.50 0.24 Septic shock 36 (38) 19 (35) 16 (50) 1 (13) 0.52 0.18 0.10 Antibiotic Penicillins 26 (27) 15 (27) 10 (30) 1 (13) 1.00 0.81 0.41 Cephalosporins 37 (39) 23 (42) 11 (33) 3 (38) 0.53 0.50 1.00 Carbapenems 40 (42) 24 (44) 14 (42) 2 (25) 0.68 1.00 0.45 Aminoglycosides 19 (20) 12 (22) 6 (18) 1 (13) 0.61 0.79 0.61 Glycopeptides 58 (60) 28 (51) 22 (67) 8 (100) 0.035 0.15 0.08 Antifungal drugs 8 (8) 3 (5) 4 (12) 1 (13) 0.28 0.42 1.00 Infectious disease consultation 89 (93) 48 (87) 33 (100) 8 (100) 0.019 0.042 NA AKI stage 0.13 0.13 NA Stage 1 68 (77) 44 (80) 24 (73) NA Stage 2 15 (17) 10 (18) 5 (15) NA Stage 3 5 (6) 1 (2) 4 (12) NA AKI stage ≥ 2 20 11 9 NA NA 0.44 NA AKI stage 3 5 1 4 NA NA 0.06 NA Number of SCr measurements d 7 [4.3–9.8] 7 [ 4 – 9 ] 9 [4.5–13.5] 6.5 [4.3–8.8] 0.12 0.07 0.28 Time from onset to kidney injury e 1 [0–3] 0 [0–1] 2 [ 1 – 4 ] 10 [8.3–15] < 0.001 < 0.001 < 0.001 Duration of kidney injury 4 [ 2 – 10 ] 2 [ 1 – 3 ] 10.5 [8-16.8] 20 [ 11 – 31 ] < 0.001 < 0.001 0.19 Values are expressed as numbers (%) or median [interquartile range] AKD , acute kidney diseases and disorders; AKI , acute kidney injury; CRBSI , catheter-related bloodstream infection; GPR, Gram positive rods; GNC, Gram negative cocci; GNR, Gram negative rods; GPC, gram-positive cocci; SCr , serum creatinine; UTI , urinary tract infection a P values compare AKI without AKD (n = 55) versus AKD (with or without AKI, n = 41). b P values compare AKI without AKD (n = 55) versus AKD (with AKI, n = 33). c P values compare AKD with AKI (n = 33) versus AKD without AKI, n = 8). d Number of Cr measurements within 7 days after the index day e Time from positive blood culture to the onset of kidney injury Source of infection and pathogens Catheter-related BSI was the most common source of infection, followed by urinary tract infection (UTI) (Table 1 ). Overall, gram stain categories (GPCs) did not differ significantly between the patients with and without AKD (P = 0.75). Descriptively, the highest number of episodes was caused by GPCs (46/96, 48%). The most frequently isolated organisms were coagulase-negative Staphylococci (n = 19), followed by Staphylococcus aureus (n = 14) (Supplemental Table 1). Risk factors for AKD in patients with bacteremia Table 2 shows the results of univariable and multivariable logistic regression analyses for AKD (with or without AKI) development. In multivariable analysis adjusting for intensive care unit onset, glycopeptide exposure, and white blood cell count, younger age (odds ratio [OR], 0.91; 95% confidence interval [CI], 0.83–0.99; P = 0.046) was associated with the development of AKD. Table 2 Univariate and multivariate logistic regression analyses of risk factors for AKD Univariate Multivariate Odds ratio * 95%CI P -value Odds ratio * 95%CI P -value Age 0.91 0.84–0.99 0.019 0.91 0.83–0.99 0.046 Body weight (per 1 kg) 0.96 0.93–0.99 0.017 Primary disease of kidney disease 2.86 0.53–21.4 0.22 ICU onset 2.37 0.91–6.45 0.08 1.84 0.61–5.57 0.28 GPC 1.50 0.66–3.40 0.33 CRBSI 1.09 0.47–2.54 0.84 UTI 2.19 0.58–9.08 0.25 Glycopeptides 2.63 1.12–6.46 0.026 1.47 0.56–3.89 0.43 White blood cell (10 3 /µL) 0.96 0.91–1.01 0.12 0.95 0.90–1.01 0.12 Hemoglobin (g/dL) 0.99 0.84–1.16 0.87 Albumin (g/dL) 0.70 0.40–1.19 0.19 Septic shock 1.40 0.60–3.25 0.43 95%CI, 95% confidence interval; AKD , acute kidney diseases and disorders; AKI , acute kidney injury; CRBSI , catheter-related bloodstream infection; GPC, gram-positive cocci; ICU , intensive care unit; UTI , urinary tract infection *Odds ratios for continuous variables are expressed per unit increase (e.g., per year for age). Risk factors for AKD with AKI in patients with bacteremia Table 3 shows the analysis of risk factors for the development of AKD with AKI. This analysis compared AKD with AKI versus AKI without AKD (n = 88) and excluded patients with AKD without AKI. In multivariable analysis, younger age (OR, 0.88 per year; 95% CI, 0.80–0.97; P = 0.018), primary kidney disease (OR, 10.3; 95% CI, 1.22–112.0; P = 0.036), UTI (OR, 7.22; 95% CI, 1.26–50.0; P = 0.031), and a lower albumin level (OR, 0.44 per 1 g/dL; 95% CI, 0.19–0.92; P = 0.037) were independently associated with the development of AKD with AKI. Table 3 Univariate and multivariate logistic regression analyses of risk factors for AKD with AKI Univariate Multivariate Odds ratio * 95%CI P -value Odds ratio * 95%CI P -value Age 0.92 0.84–0.99 0.046 0.88 0.80–0.97 0.018 Body weight (per 1 kg) 0.97 0.93–0.99 0.041 Primary disease of kidney disease 3.66 0.67–27.5 0.13 10.3 1.22–112.0 0.036 ICU onset 2.22 0.79–6.35 0.13 2.93 0.90–9.89 0.08 GPC 1.22 0.51–2.90 0.66 CRBSI 1.08 0.44–2.67 0.86 UTI 2.83 0.75–11.9 0.13 7.22 1.26-50.0 0.031 Glycopeptides 1.93 0.80–4.84 0.15 White blood cell (10 3 /µL) 0.99 0.92–1.02 0.30 Hemoglobin (g/dL) 0.95 0.79–1.12 0.53 Albumin (g/dL) 0.59 0.31–1.05 0.07 0.44 0.19–0.92 0.037 Septic shock 1.89 0.78–4.61 0.16 AKI stage ≥ 2 1.50 0.54–4.14 0.43 AKI stage 3 7.45 0.79–69.8 0.045 8.21 0.98–181.4 0.08 95% CI, 95% confidence interval; AKD , acute kidney diseases and disorders; AKI , acute kidney injury; CRBSI , catheter-related bloodstream infection; GPC, gram-positive cocci; ICU , intensive care unit; UTI , urinary tract infection Analysis was restricted to patients with AKD with AKI and those with AKI without AKD (n = 88); AKD without AKI was excluded. *Odds ratios for continuous variables are expressed per unit increase (e.g., per year for age). Kidney outcomes and mortality Table 4 shows the analysis of kidney outcomes and mortality. Compared with AKI without AKD (0/55), those with AKD group (with or without AKI) had significantly higher rates of death (6/41, 15%; P = 0.005) and MAKE 30 (7/41, 17%; P = 0.002) and MAKE90 (8/41, 20%; P < 0.001). All adverse outcomes occurred in the AKD with AKI subgroup. Table 4 Kidney outcome and mortality Total (n = 96) AKI without AKD (n = 55) AKD (n = 41) P value* AKD with AKI (n = 33) AKD without AKI (n = 8) KRT during hospitalization 5 (5) 1 (2) 4 (12) 0 (0) 0.16 CKD stage ≥ 3 2 (2) 0 (0) 2 (6) 0 (0) 0.18 Death 6 (6) 0 (0) 6 (18) 0 (0) 0.005 MAKE30 7 (7) 0 (0) 7 (21) 0 (0) 0.002 MAKE90 8 (8) 0 (0) 8 (24) 0 (0) < 0.001 Values are expressed as numbers (%) or median [interquartile range] AKI , acute kidney injury; AKD , acute kidney diseases and disorders; CKD , chronic kidney disease; KRT , kidney replacement therapy; MAKE30 , major adverse kidney events at 30 days; MAKE90 , major adverse kidney events at 90 days; * P values compare AKI without AKD (= 55) versus AKD (with or without AKI, n = 41). Supplemental Table 2 summarizes the characteristics of eight patients with MAKE90 in the study cohort, revealing that all eight patients developed AKD and that most events were attributable to death, with several cases occurring in infants. Discussion In this single-center, retrospective, observational study, we examined the frequency of AKD, clinical predictors of AKD development, and kidney outcomes and mortality among pediatric patients with BSI-associated kidney injury. In the study cohort, 41 patients (43%), including 8 (8%) who developed AKD without AKI, developed BSI-associated AKD. Logistic regression analysis revealed that younger age was an independent risk factor for BSI-associated AKD. Moreover, 2 patients progressed to CKD and 6 patients died, whereas 7 and 8 patients developed MAKE30 and MAKE90, respectively; all these patients had AKD with AKI. The rates of death, MAKE30, and MAKE90 were higher in patients with AKD than in those with AKI without AKD. In the present cohort, 43% of the patients with BSI-associated kidney dysfunction developed AKD. Pediatric data on AKD remain limited, and reported frequencies widely vary across clinical settings, reflecting differences in patient populations (including underlying diagnosis and illness severity), AKD ascertainment, and follow-up intensity (Table 5 ) [ 14 – 28 ]. In BSI, sustained kidney dysfunction can reflect not only initial hemodynamic perturbations but also persistent inflammatory and immune-mediated injury affecting microcirculation, vascular endothelium, and tubular epithelium, with potential contribution from treatment-associated factors and difficulty in infection source control in device-associated infections [ 5 , 29 – 31 ]. Table 5 Frequency and outcome of pediatric patients with AKD Study Clinical area N (Overall) AKD frequency n, (%) Denominator definition Mortality Incident CKD Daraskevicius et al., 2020 14 Allogeneic HSCT 51 18/51 (35%) Pediatric allogeneic HSCT recipients AKD 17% vs no AKD 3% NA LoBasso et al., 2022 15 Cardiac surgery (CPB/PICU) 3620 44/701 (3%) Children with AKI HR 3.7 (95%CI 1.7–7.9) /non-AKI NA Namazzi et al., 2022 16 Severe malaria 598 72/462 (16%) Children with severe malaria AKD 9.7% vs no AKD 2.6% NA Deng et al., 2022 17 Hospitalized pediatric AKI 990 419/990 (42%) Children with AKI AKD stage2-3 vs stage0-1, 3-fold (on day 30) AKD stage 2–3 0.5% vs stage 0–1 3% Patel et al., 2022 18 Non-kidney solid organ transplant 338 44/338 (13%) Children undergoing non-kidney solid organ transplantation NA OR 29.74 (95%CI 11.22–78.82) Hui et al., 2023 19 PICU admissions 254 14/25 (56%) Children who stayed in PICU for ≥ 7 days RR 7.2 (95%CI 0.4–121.0) NA Patel et al., 2023 20 Hospitalized AKI cohort 528 297/528 (56%) Children with AKI OR 4.77 (95%CI 3.0-7.6) OR 4.0 (95%CI 2.2–7.4) Batte et al., 2023 21 Sickle cell anemia 185 129/185 (70%) Children with sickle cell anemia OR 2.01 (95%CI 1.08–3.83) NA Murdeshwar et al., 2023 22 Nephrology clinic/PICU mix AKI cohort 5710 200/5710 (4%) Children with AKI 19% 16% Xu et al., 2024 23 General hospitalized population 2346 279/1685 (16%) Hospitalized pediatric patients AKD with AKI 6.9% vs AKD without AKI 1.5% vs AKI without AKD 5.6% NA Chisavu et al., 2024 24 Hospitalized AKI cohort 736 125/736 (17%) Children with AKI OR 2.65 (95%CI 1.38–5.1) OR 22.96 (95%CI 2.38-220.98) Nishi et al., 2025 25 Neonatal AKI (NICU) 280 85/280 (30%) Neonates with AKI AKD 8% vs no AKD 2% AKD 11% vs no AKD 5% Alyahyawi et al., 2025 26 DKA / T1D 373 131/299 (44%) Children with DKA who developed AKI 0% NA Karmakar et al., 2025 27 PICU AKI cohort 390 38/57 (67%) Children with AKI AKD 42% vs no AKD 12% AKD 38% vs no AKD 6% Mauroner et al., 2025 28 Critically ill children (PICU) 5922 1199/5922 (20%) Children admitted to the PICU AKD 2% vs no AKD 1.1% AKD 24% vs no AKD 2.5% Present study Bacteremia 1427 41/96 (43%) Children with bacteremia who developed kidney dysfunction AKD with AKI 18% vs AKD without AKI 0% vs AKI without AKD 0% AKD with AKI 6% vs AKD without AKI 0% vs AKI without AKD 0% AKD , acute kidney disease; AKI , acute kidney injury; DKA , diabetic ketoacidosis; HSCT , hematopoietic stem cell transplantation; NA , not available; PICU , pediatric intensive care unit; T1D, diabetes mellitus type 1 Notably, 8% of the overall cohort (20% of patients with AKD) met the AKD criteria without fulfilling the AKI criteria during the first 7 days. This AKD without AKI phenotype has been increasingly recognized in adult populations [ 2 , 32 , 33 ], but pediatric evidence remains scarce. AKD can develop even in some cases where AKI is not detected early after BSI. Due to the small number of patients with AKD without AKI in the present study, larger pediatric studies are warranted to confirm our findings. In the present study cohort, compared with AKD with concomitant AKI, AKD without AKI tended to be associated with gram-positive cocci infection and glycopeptide use and was associated with lower C-reactive protein levels, suggesting heterogeneity in underlying mechanisms. The phenotype of AKD without AKI may be influenced less by the intrinsic severity of bacteremia and more by post-BSI management factors, including antimicrobial exposure and supportive care. Our analyses revealed younger age as an independent predictor of BSI-associated AKD. Younger children may have limited renal functional reserve and greater vulnerability to hemodynamic stress and treatment exposure during severe infection, all of which can predispose to delayed renal recovery beyond day 7. We also assessed risk factors for AKD in the overall cohort and among patients with AKI, including those with and without AKD, to characterize the determinants of the phenotype of AKD with AKI. In the multivariable analysis restricted to patients with AKI, younger age, underlying kidney disease, UTI as the presumed source of bacteremia, and lower serum albumin levels were independently associated with the phenotype of AKD with AKI. Pediatric studies have consistently shown that greater AKI severity and persistence are key determinants of AKD, whereas intrinsic kidney disease has also been implicated as a high-risk substrate for incomplete renal recovery [ 17 , 19 , 20 , 22 ]. Our findings are broadly concordant with these observations, while additionally suggesting that infection source and host vulnerability, reflected by hypoalbuminemia, contribute to delayed recovery in pediatric patients with BSI. GPCs, particularly Staphylococcus aureus , have been associated with an increased risk of AKI [ 34 ]. However, we did not observe a significant association between GPCs and AKD in our cohort. Although often reported as a strong predictor of AKD [ 18 ], stage 3 AKI was not a statistically significant factor in our cohort, likely due to the limited power and overlap with other severity-related covariates. Pediatric studies consistently show that AKD is associated with worse outcomes, including higher mortality and a greater risk of incident CKD (Table 5 ). In the present study, adverse outcomes, including MAKE30 and MAKE90, were observed exclusively among patients who developed AKD. Although the small number of events in our cohort precluded robust risk modeling for MAKE endpoints and mortality, the direction of the association is consistent with previous reports [ 17 , 28 ]. Importantly, these findings should be interpreted with caution because death may act as a competing outcome and AKD may also be an indicator of overall illness severity rather than a direct causal mediator. In our cohort, deaths were attributable to systemic complications, such as multiple organ failure and pneumonia, hindering our ability to determine whether BSI-associated AKD independently contributed to mortality. Nonetheless, persistent kidney dysfunction after severe infection may plausibly reflect sustained microcirculatory dysfunction and inflammatory/tubular injury, which are linked to both AKD and adverse outcomes. Larger multicentre studies are warranted to clarify the independent prognostic impact of BSI-associated AKD and its relationship with MAKE and subsequent CKD. Further research should also investigate the association between BSI-associated AKD and mortality. This study had several limitations. First, SCr measurements were not standardized, given the retrospective study design. Nevertheless, SCr levels were frequently monitored during the first week after the index day, with a median of seven measurements. Second, data on cystatin C and kidney injury biomarkers, such as L-type fatty acid-binding protein and neutrophil gelatinase-associated lipocalin, were unavailable in this retrospective study. Third, management of bacteremia was not standardized, although the same infectious disease team reviewed antimicrobial selection and duration in most patients. Finally, multivariable modeling could not be performed with death or MAKE as endpoints, given that no such events occurred in patients without AKD, resulting in insufficient outcome variation for reliable estimation. In conclusion, in the present single-center cohort of pediatric patients with BSI and kidney dysfunction, AKD occurred in a substantial proportion, including a small subgroup of patients who developed AKD without meeting the AKI criteria. Younger age was independently associated with AKD development, and adverse outcomes occurred only among those with AKD. These findings support the importance of structured kidney follow-up during the first 7–90 days after BSI-associated kidney injury and warrant confirmation in larger multicentre studies. Declarations Acknowledgments: We thank Enago (Crimson Interactive Pvt. Ltd.) for English language editing. We used ChatGPT (OpenAI) to assist with language editing; all outputs were reviewed and edited by the authors, who take full responsibility for the content. Conflict of interest statement: Koichi Kamei has received research funding from the Public Foundation of Vaccination Research Center and the Taiju Life Social Welfare Foundation; donations from Chugai Pharmaceutical Co. Ltd., Teijin Pharma Ltd., Kyowa Kirin Co. Ltd., Shionogi & Co. Ltd., Daiichi Sankyo Co. Ltd., Mitsubishi Tanabe Pharma Co. Ltd, and Otsuka Pharmaceutical Co. Ltd.; and lecture fees from Terumo Co. Ltd., Baxter Ltd., and Zenyaku Kogyo Co., Ltd. Other authors declare no competing interests. Funding: We did not receive any external funding for this study. Data availability statement: The datasets generated and/or analyzed during the current study are not publicly available due to ethical restrictions and institutional policies but are available from the corresponding author on reasonable request. Ethics approval : This study was approved by the Ethics Committee of the National Center for Child Health and Development (approval no. 2023-298). The requirement for informed consent was waived due to the retrospective study design. Authors’ contributions: MA prepared the first draft of the manuscript and performed data collection and analysis. TM contributed to data collection and provided infectious disease-related clinical input. HC contributed to data collection. SO, TK, MO, NT, KT, KI, SM, and KK edited and reviewed the manuscript for intellectual content. KN contributed to the study conception and methodology, performed and supervised the data analysis, and critically revised the manuscript as the corresponding author. All authors reviewed and approved the final manuscript. References Lameire NH, Levin A, Kellum JA et al (2021) Harmonizing acute and chronic kidney disease definition and classification: report of a Kidney Disease: Improving Global Outcomes (KDIGO) Consensus Conference. 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Front Pediatr 10:1039024. https://doi.org/10.3389/fped.2022.1039024 Khwaja A (2012) KDIGO clinical practice guidelines for acute kidney injury. Nephron Clin Pract 120:c179–184. https://doi.org/10.1159/000339789 Chawla LS, Bellomo R, Bihorac A et al (2017) Acute kidney disease and renal recovery: consensus report of the acute disease quality initiative (ADQI) 16 workgroup. Nat Rev Nephrol 13:241–257. https://doi.org/10.1038/nrneph.2017.2 Kidney Disease: Improving Global Outcomes CKD Work Group (2012) KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int Suppl 3:S1–S150 Uemura O, Honda M, Matsuyama T et al (2011) Age, gender, and body length effects on reference serum creatinine levels determined by an enzymatic method in Japanese children: a multicenter study. Clin Exp Nephrol 15:694–699. https://doi.org/10.1007/s10157-011-0452-y Uemura O, Ishikura K, Gotoh Y et al (2018) Creatinine- based estimated glomerular filtration rate for children younger than 2 years. Clin Exp Nephrol 22:483–484. https://doi.org/10.1007/s10157-017-1460-3 Xiao YQ, Cheng W, Wu X et al (2020) Novel risk models to predict acute kidney disease and its outcomes in a Chinese hospitalized population with acute kidney injury. Sci Rep 10:15636. https://doi.org/10.1038/s41598-020-72651-x Goldstein B, Giroir B, Randolph A et al (2005) International pediatric sepsis consensus conference: definitions for sepsis and organ dysfunction in pediatrics. Pediatr Crit Care Med 6:2–8. https://doi.org/10.1097/01 Daraskevicius J, Azukaitis K, Dziugeviciute-Tupko J et al (2020) Phenotypes and Baseline Risk Factors of Acute Kidney Injury in Children After Allogeneic Hematopoietic Stem Cell Transplantation. Front Pediatr 8:499. https://doi.org/10.3389/fped.2020.00499 LoBasso M, Schneider J, Sanchez-Pinto LN et al (2022) Acute kidney injury and kidney recovery after cardiopulmonary bypass in children. Pediatr Nephrol 37:659–665. https://doi.org/10.1007/s00467-021-05179-5 Namazzi R, Batte A, Opoka RO et al (2022) Acute kidney injury, persistent kidney disease, and post-discharge morbidity and mortality in severe malaria in children: A prospective cohort study. EClinicalMedicine 12:44101292. https://doi.org/10.1016/j.eclinm.2022.101292 Deng YH, Yan P, Zhang NY et al (2022) Acute kidney disease in hospitalized pediatric patients with acute kidney injury in China. Front Pediatr 10:885055. https://doi.org/10.3389/fped.2022.885055 Patel M, Heipertz A, Joyce E et al (2022) Acute kidney disease predicts chronic kidney disease in pediatric non-kidney solid. organ Transpl patients 26:e14172. https://doi:10.1111/petr.14172 Hui WF, Chan VPY, Cheung WL et al (2023) Risk factors for development of acute kidney injury and acute kidney disease in critically ill children. J Nephrol 36:1425–1434. https://doi.org/10.1007/s40620-023-01613-z Patel M, Hornik C, Diamantidis C et al (2023) Patient level factors increase risk of acute kidney disease in hospitalized children with acute kidney injury. Pediatr Nephrol 38:3465–3474. https://doi.org/10.1007/s00467-023-05997-9 Batte A, Kasirye P, Baluku R et al (2023) Mineral bone disorders and kidney disease in hospitalized children with sickle cell anemia. Front Pediatr 10:1078853. https://doi.org/10.3389/fped.2022.1078853 Murdeshwar A, Krishnamurthy S, Parameswaran N et al (2023) Etiology and outcomes of acute kidney disease in children: a cohort study. Clin Exp Nephrol 27:548–556. https://doi.org/10.1007/s10157-023-02339-9 Xu L, Jiang S, Li C et al (2024) Acute kidney disease in hospitalized pediatric patients: risk prediction based on an artificial intelligence approach. Ren Fail 46:2438858. https://doi.org/10.1080/0886022X.2024.2438858 Chisavu F, Chisavu L, Ivan V et al (2024) Acute Kidney Disease following Acute Kidney Injury in Children-A Retrospective Observational Cohort Study on Risk Factors and Outcomes. J Clin Med 13:3145. https://doi.org/10.3390/jcm13113145 Nishi K, Fukui K, Matsui T et al (2025) Neonatal acute kidney disease in the National Center for Child Health and Development (NCCHD)-neoAKI cohort: risk factors and prognostic outcomes. Pediatr Nephrol 41:845–852. https://doi.org/10.1007/s00467-025-07011-w Alyahyawi N, Alghamdi D, Almahmoudi A et al (2025) Risk factors of acute kidney injury in children with diabetic ketoacidosis. BMC Nephrol 26:254. https://doi.org/10.1186/s12882-025-04178-0 Karmakar S, Dasgupta D, Akhtar S et al (2025) Progression of acute kidney injury to chronic kidney disease: a prospective cohort study. Pediatr Nephrol 40:3293–3300. https://doi.org/10.1007/s00467-025-06810-5 Mauroner L, Kellum JA, Levey AS et al (2025) The Incidence and Outcomes of Acute Kidney Disease in Critically Ill Children. Kidney360 6:543–549. https://doi.org/10.34067/KID.0000000693 Langenberg C, Wan L, Egi M, May CN, Bellomo R (2006) Renal blood flow in experimental septic acute renal failure. Kidney Int 69:1996–2002. https://doi.org/10.1038/sj.ki.5000440 Zarbock A, Nadim MK, Pickkers P et al (2023) Sepsis-associated acute kidney injury: consensus report of the 28th Acute Disease Quality Initiative workgroup. Nat Rev Nephrol 19:401–417. https://doi:10.1038/s41581-023-00683-3 Ostermann M, Lumlertgul N, Jeong R, See E, Joannidis M, James M (2025) Acute kidney injury. Lancet 405:241–256. https://doi:10.1016/S0140-6736(24)02385-7 Xu L, Li C, Li N et al (2023) Incidence and prognosis of acute kidney injury versus acute kidney disease among 71041 inpatients. Clin Kidney J 16:1993–2002. https://doi.org/10.1093/ckj/sfad208 See EJ, Polkinghorne KR, Toussaint ND et al (2021) Epidemiology and Outcomes of Acute Kidney Diseases: A Comparative Analysis. Am J Nephrol 52:342–350. https://doi.org/10.1159/000515231 Buis DTP, van der Vaart TW, Mohan A et al (2024) Acute kidney injury in Staphylococcus aureus bacteraemia: a recurrent events analysis. Clin Microbiol Infect 30:1270–1275. https://doi:10.1016/j.cmi.2024.06.017 Supplementary Files graphicabstractpediatricnephrology.pptx STROBEchecklistv4cohort.doc SupplementalTable.docx Cite Share Download PDF Status: Under Review Version 1 posted Reviewers agreed at journal 13 Apr, 2026 Reviewers invited by journal 13 Apr, 2026 Editor assigned by journal 10 Apr, 2026 First submitted to journal 06 Apr, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9332681","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":622284544,"identity":"c3adc3e6-ac0b-4b32-9c6e-b847fdc33867","order_by":0,"name":"Misaki Akiyama","email":"","orcid":"","institution":"National Center for Child Health and Development","correspondingAuthor":false,"prefix":"","firstName":"Misaki","middleName":"","lastName":"Akiyama","suffix":""},{"id":622284545,"identity":"31f9825d-921a-4f86-88e0-c0d30dc5c795","order_by":1,"name":"Kentaro 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Development","correspondingAuthor":false,"prefix":"","firstName":"Koichi","middleName":"","lastName":"Kamei","suffix":""}],"badges":[],"createdAt":"2026-04-06 10:22:25","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9332681/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9332681/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":107356630,"identity":"fa9587b9-5906-48af-b8fa-cb035be6c9f0","added_by":"auto","created_at":"2026-04-20 17:02:21","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":401311,"visible":true,"origin":"","legend":"\u003cp\u003eStudy flow diagram showing patient selection\u003c/p\u003e\n\u003cp\u003eAKI, acute kidney injury; AKD, acute kidney disease; BSI, bloodstream infection; CKD, chronic kidney disease; KRT, kidney replacement therapy\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-9332681/v1/d4b3a4b2bc18a2184177bb62.png"},{"id":107489697,"identity":"154ab08d-0962-47ab-9ad1-ff3dde0719ce","added_by":"auto","created_at":"2026-04-22 02:48:38","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1267262,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9332681/v1/96bfb9aa-bea9-4a91-8005-af9d83e02f78.pdf"},{"id":107488529,"identity":"8abf0493-e135-4481-9cc3-f896ecb05728","added_by":"auto","created_at":"2026-04-22 02:44:59","extension":"pptx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":116071,"visible":true,"origin":"","legend":"","description":"","filename":"graphicabstractpediatricnephrology.pptx","url":"https://assets-eu.researchsquare.com/files/rs-9332681/v1/9cea1f70c9c77e4266ccd2b8.pptx"},{"id":107356632,"identity":"db577157-2012-41cb-b90d-377ca4113c1d","added_by":"auto","created_at":"2026-04-20 17:02:21","extension":"doc","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":91136,"visible":true,"origin":"","legend":"","description":"","filename":"STROBEchecklistv4cohort.doc","url":"https://assets-eu.researchsquare.com/files/rs-9332681/v1/3398b04ff7f6363d81eef2ac.doc"},{"id":107356633,"identity":"8388725a-68fa-4ab4-8108-fba7163831e9","added_by":"auto","created_at":"2026-04-20 17:02:21","extension":"docx","order_by":3,"title":"","display":"","copyAsset":false,"role":"supplement","size":23128,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementalTable.docx","url":"https://assets-eu.researchsquare.com/files/rs-9332681/v1/b2999f19fb20b9c0d9f846d7.docx"}],"financialInterests":"","formattedTitle":"Acute kidney diseases and disorders in children with bloodstream infection: frequency, predictors, and outcomes","fulltext":[{"header":"Introduction","content":"\u003cp\u003eAcute kidney diseases and disorders (AKD) are a recently established set of criteria defined as acute or subacute kidney dysfunction that persists for 7\u0026ndash;90 days after an initiating event [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. AKD extends the acute kidney injury (AKI) framework by focusing on kidney dysfunction during recovery and transition, thereby aiding in identifying patients at risk of progression to chronic kidney disease (CKD). Importantly, AKD can also capture clinically meaningful kidney dysfunction that does not fulfill the conventional AKI criteria but persists within the AKD time window [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eBloodstream infection (BSI), a common presentation in hospitalized children, is associated with an increased risk of AKI, particularly in critically ill patients [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Severe BSI can predispose adult patients to subsequent AKD [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. However, evidence on BSI-associated AKD in children, including frequency, clinical predictors, and outcomes, remains limited. Given that risk profiles and clinical trajectories vary across patient populations, risk stratification tools tailored to specific clinical settings are needed [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Therefore, we aimed to evaluate the frequency of AKD among children with BSI-associated kidney dysfunction (AKI and/or AKD) and to identify clinical predictors of AKD development. Our primary objective was to identify predictors of BSI-associated AKD; secondary objectives included kidney outcomes and mortality. Our findings should enable stratification of patients at high risk of AKD, thereby promoting early intervention and appropriate management.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design, site, and participants\u003c/h2\u003e \u003cp\u003eThis single-center, retrospective, observational study included patients aged\u0026thinsp;\u0026lt;\u0026thinsp;20 years who presented with BSI-associated kidney dysfunction between 1 May 2013 and 31 May 2023. Patients with the diagnosis of BSI with subsequent kidney injury (AKI or AKD) during the same infectious episode were included. Conversely, neonates, patients with stage 3\u0026ndash;5 CKD before the index infection, those who underwent kidney replacement therapy (KRT) for causes other than kidney failure, and those who did not undergo follow-up evaluation for serum creatinine (SCr) levels to adjudicate AKI/AKD status were excluded. Additionally, in patients who experienced multiple episodes of BSI-associated kidney dysfunction during the study period, only the first episode was included in study analyses. Given that AKD is defined by kidney dysfunction persisting beyond day 7 of onset, patients who died within 7 days of the index day were not evaluated for AKD and were excluded from AKD analysis.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eData collection\u003c/h3\u003e\n\u003cp\u003eAnonymized data were extracted using the hospital patient management system. The following data were collected from medical records to determine patients\u0026rsquo; clinical course: sex, age, body weight, primary disease, place of onset, source of infection, causative pathogen, blood tests, antibiotic, infectious disease consultation, number of SCr measurements on days 0\u0026ndash;7, sepsis, septic shock, AKI grade, time from positive blood culture to the onset of kidney injury, duration of kidney injury, and kidney and life outcomes.\u003c/p\u003e\n\u003ch3\u003eStudy outcomes\u003c/h3\u003e\n\u003cp\u003ePrimary endpoint was the frequency of AKD among children with BSI-associated kidney injury. Secondary endpoints were kidney outcomes (KRT requirement, CKD, and major adverse kidney events at days 30 and 90 [MAKE30 and MAKE90, respectively]), and mortality. We also evaluated clinical predictors of AKD development.\u003c/p\u003e\n\u003ch3\u003eDefinitions\u003c/h3\u003e\n\u003cp\u003eThe index day, i.e., day 0, was defined as the date of first positive blood culture during the index infectious episode. AKI was assessed during days 0\u0026ndash;7, and AKD was assessed during days 7\u0026ndash;90 after the index infectious episode. BSI was defined as the isolation of clinically significant microorganisms from blood cultures. Commensal organisms recovered from a single blood culture set were regarded as contaminants. AKI was defined according to the Kidney Disease: Improving Global Outcomes (KDIGO) criteria [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. AKD was defined as kidney dysfunction persisting between days 7 and 90 after the index day, according to the KDIGO/Acute Disease Quality Initiative criteria [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Due to the retrospective study design, data on urine output were available in only 12 patients; therefore, AKI and AKD adjudication and staging were primarily based on SCr levels. AKD may occur with or without meeting the AKI criteria during the first 7 days [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Therefore, we identified and described cases of AKD without AKI, defined as kidney dysfunction meeting AKD criteria during days 7\u0026ndash;90 without meeting AKI criteria during days 0\u0026ndash;7. CKD was defined as an estimated glomerular filtration rate of \u0026lt;\u0026thinsp;60 mL/min/1.73 m\u003csup\u003e2\u003c/sup\u003e persisting for at least 3 months [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. The reference, i.e., baseline, SCr levels were hierarchically defined. When available, the most recent SCr value obtained prior to the index day was used. In cases without available preindex SCr levels, reference SCr levels were imputed using age- and sex-specific normative values for Japanese children [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Estimated glomerular filtration rate was calculated using the creatinine-based equation developed for Japanese children with CKD [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. MAKE30 and MAKE90 were defined as composite outcomes of mortality, dialysis dependence, or CKD at days 30 and 90 after the index day, respectively [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Sepsis was defined according to the Goldstein pediatric consensus criteria [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e], and septic shock was defined as sepsis with cardiovascular dysfunction [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eAll statistical analyses were performed using JMP Pro 16 (SAS Institute Japan, Tokyo, Japan). Values were expressed as medians with interquartile ranges for continuous variables and percentages for categorical variables. For descriptive purposes, patients were categorized into three groups: AKI without AKD, AKD with AKI, and AKD without AKI. For primary comparative analyses, patients were dichotomized as those with AKD (with or without AKI) versus those with AKI without AKD. Continuous variables were compared using the Mann\u0026ndash;Whitney \u003cem\u003eU\u003c/em\u003e test, whereas categorical variables were compared using Fisher\u0026rsquo;s exact or the chi-square test. Logistic regression was employed to evaluate predictors of AKD development. Covariates were selected \u003cem\u003ea priori\u003c/em\u003e based on clinical relevance and to avoid overfitting, given the number of events. First, univariable logistic regression was used to assess each covariate. Variables with P values of \u0026lt;\u0026thinsp;0.15 in univariable analyses, as well as clinically important factors, were entered into a multivariable logistic regression model to identify independent predictors of AKD development. In an additional multivariable regression model focused on the AKD with AKI phenotype, analyses were restricted to patients with AKD with AKI and those with AKI without AKD, by excluding those with AKD without AKI. A two-sided P-value of \u0026lt;\u0026thinsp;0.05 was considered to indicate statistical significance.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eEthics\u003c/h2\u003e \u003cp\u003eThe study was approved by the Institutional Ethics Committee of the National Center for Child Health and Development (approval no. 2023\u0026thinsp;\u0026minus;\u0026thinsp;298) and conducted in accordance with the principles of the Declaration of Helsinki and the Ethical Guidelines for Medical and Health Research Involving Human Subjects of the Ministry of Health, Labor, and Welfare, Japan. Informed consent was waived due to the retrospective study design.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003ePatient characteristics\u003c/h2\u003e \u003cp\u003eDuring the study period, 1427 patients had positive blood cultures. After excluding 1195 patients without AKI or AKD and 35 cases with contaminated blood cultures, the remaining 197 patients (14.1%) comprised the cohort of patients with BSI-associated kidney dysfunction. The final analysis included 96 patients, after excluding 70 neonates, 18 patients with stage 3\u0026ndash;5 CKD before the index infection, 6 patients who underwent KRT for causes other than kidney disease, 6 patients who did not undergo SCr follow-up, and 1 patient with a subsequent BSI-associated kidney dysfunction episode (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). In the final cohort, no patients died within the first 7 days of the index day.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e summarizes the patient characteristics across the three groups: AKI without AKD (n\u0026thinsp;=\u0026thinsp;55), AKD with AKI (n\u0026thinsp;=\u0026thinsp;33), and AKD without AKI (n\u0026thinsp;=\u0026thinsp;8). The analyses included three comparisons: (i) AKD (with or without AKI; n\u0026thinsp;=\u0026thinsp;41) versus AKI without AKD (n\u0026thinsp;=\u0026thinsp;55), (ii) AKD with AKI (n\u0026thinsp;=\u0026thinsp;33) versus AKI without AKD (n\u0026thinsp;=\u0026thinsp;55), and (iii) AKD with AKI (n\u0026thinsp;=\u0026thinsp;33) versus AKD without AKI (n\u0026thinsp;=\u0026thinsp;8). Patients with AKD were younger and had lower body weight than those with AKI without AKD. The interval from the first positive blood culture to kidney injury onset and the duration of kidney injury were longer in the AKD group. Other baseline characteristics were similar between groups. In subgroup analysis comparing the patients with AKD with AKI and those with AKD without AKD, Gram-positive cocci infections and glycopeptide use tended to be more frequent and the C-reactive protein levels were significantly lower in patients with AKD without AKI than in those with AKD with AKI.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePatient characteristics and comparison between patients with and without AKD\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;96)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAKI without AKD \u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;55)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eAKD\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;41)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP- value\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eP- value\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eP- value\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAKD with AKI\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;33)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAKD without AKI\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;8)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e72 (75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e41 (75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26 (79)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5 (63)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.38\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.0 [1.0-10.7]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.6 [1.9\u0026ndash;11.7]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.8 [0.5\u0026ndash;9.1]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.7 [0.9\u0026ndash;6.5]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.025\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.046\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.90\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBody weight (kg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14.2 [7.7\u0026ndash;28.7]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17 [9.2\u0026ndash;33.0]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12.4 [5.0-24.6]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10.2 [7.9\u0026ndash;21.7]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.030\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.052\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.86\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimary disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRespiratory\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8 (8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCardiovascular\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20 (21)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8 (15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8 (24)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4 (50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeurological\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16 (17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (18)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5 (15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGastrointestinal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e39 (41)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23 (42)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11 (33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5 (63)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.22\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHemato-0ncology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20 (21)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12 (22)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7 (21)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKidney\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.57\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePlace of onset\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.72\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHome\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25 (26)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17 (31)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7 (21)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGeneral hospital\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e46 (48)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28 (51)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14 (42)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4 (50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eICU\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22 (23)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10 (30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3 (38)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNICU\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSource of infection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.47\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCRBSI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e34 (35)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19 (35)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12 (36)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3 (38)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUTI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10 (10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6 (18)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAcute cholangitis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8 (8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e32 (33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17 (31)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11 (33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4 (50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnknown\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12 (13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8 (15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePathogen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.07\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGPC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e46 (48)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24 (44)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16 (48)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6 (75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGPR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGNC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGNR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e46 (48)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29 (53)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16 (48)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003efungi\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBlood tests\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhite blood cell\u003c/p\u003e \u003cp\u003e(/\u0026micro;L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10,425 [5,537\u0026thinsp;\u0026minus;\u0026thinsp;15,892]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11,120 [5,430\u0026thinsp;\u0026minus;\u0026thinsp;19,180]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10,460 [6,490\u0026thinsp;\u0026minus;\u0026thinsp;16,000]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6,805 [4,530-9,738]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.14\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHemoglobin (g/dL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10.6 [8.8\u0026ndash;12.2]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.6 [8.6\u0026ndash;12.6]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10.4 [8.6\u0026ndash;11.9]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11.5 [10.1\u0026ndash;13.9]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.13\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlbumin (g/dL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.2 [2.7\u0026ndash;3.8]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.2 [2.7\u0026ndash;3.9]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.9 [2.5\u0026ndash;3.4]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.7 [2.5\u0026ndash;4.1]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.12\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eC-reactive protein\u003c/p\u003e \u003cp\u003e(mg/dL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.1 [1.3\u0026ndash;11.7]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.4 [1.3\u0026ndash;12.1]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.4 [2.5\u0026ndash;12.7]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.8 [0.3\u0026ndash;4.5]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.005\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSepsis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e55 (57)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35 (64)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18 (55)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2 (25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.24\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSeptic shock\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e36 (38)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19 (35)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16 (50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.10\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAntibiotic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePenicillins\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26 (27)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15 (27)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10 (30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.41\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCephalosporins\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e37 (39)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23 (42)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11 (33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3 (38)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCarbapenems\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40 (42)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24 (44)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14 (42)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2 (25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.45\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAminoglycosides\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19 (20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12 (22)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6 (18)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.61\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGlycopeptides\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e58 (60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28 (51)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22 (67)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.035\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.08\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAntifungal drugs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8 (8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInfectious disease\u003c/p\u003e \u003cp\u003econsultation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e89 (93)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e48 (87)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e33 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.019\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.042\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAKI stage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStage 1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e68 (77)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e44 (80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24 (73)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStage 2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15 (17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (18)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5 (15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStage 3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAKI stage\u0026thinsp;\u0026ge;\u0026thinsp;2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAKI stage 3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of SCr\u003c/p\u003e \u003cp\u003emeasurements\u003csup\u003ed\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7 [4.3\u0026ndash;9.8]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 [\u003cspan additionalcitationids=\"CR5 CR6 CR7 CR8\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9 [4.5\u0026ndash;13.5]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6.5 [4.3\u0026ndash;8.8]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.28\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTime from onset to kidney injury\u003csup\u003ee\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 [0\u0026ndash;3]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 [0\u0026ndash;1]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 [\u003cspan additionalcitationids=\"CR2 CR3\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10 [8.3\u0026ndash;15]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDuration of kidney injury\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 [\u003cspan additionalcitationids=\"CR3 CR4 CR5 CR6 CR7 CR8 CR9\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 [\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10.5 [8-16.8]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e20 [\u003cspan additionalcitationids=\"CR12 CR13 CR14 CR15 CR16 CR17 CR18 CR19 CR20 CR21 CR22 CR23 CR24 CR25 CR26 CR27 CR28 CR29 CR30\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.19\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003eValues are expressed as numbers (%) or median [interquartile range]\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003e\u003cem\u003eAKD\u003c/em\u003e, acute kidney diseases and disorders; \u003cem\u003eAKI\u003c/em\u003e, acute kidney injury; \u003cem\u003eCRBSI\u003c/em\u003e, catheter-related bloodstream infection; GPR, Gram positive rods; GNC, Gram negative cocci; GNR, Gram negative rods; GPC, gram-positive cocci; \u003cem\u003eSCr\u003c/em\u003e, serum creatinine; \u003cem\u003eUTI\u003c/em\u003e, urinary tract infection\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003e\u003csup\u003ea\u003c/sup\u003e P values compare AKI without AKD (n\u0026thinsp;=\u0026thinsp;55) versus AKD (with or without AKI, n\u0026thinsp;=\u0026thinsp;41).\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003e\u003csup\u003eb\u003c/sup\u003e P values compare AKI without AKD (n\u0026thinsp;=\u0026thinsp;55) versus AKD (with AKI, n\u0026thinsp;=\u0026thinsp;33).\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003e\u003csup\u003ec\u003c/sup\u003e P values compare AKD with AKI (n\u0026thinsp;=\u0026thinsp;33) versus AKD without AKI, n\u0026thinsp;=\u0026thinsp;8).\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003e\u003csup\u003ed\u003c/sup\u003e Number of Cr measurements within 7 days after the index day\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003e\u003csup\u003ee\u003c/sup\u003e Time from positive blood culture to the onset of kidney injury\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eSource of infection and pathogens\u003c/h2\u003e \u003cp\u003eCatheter-related BSI was the most common source of infection, followed by urinary tract infection (UTI) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Overall, gram stain categories (GPCs) did not differ significantly between the patients with and without AKD (P\u0026thinsp;=\u0026thinsp;0.75). Descriptively, the highest number of episodes was caused by GPCs (46/96, 48%). The most frequently isolated organisms were coagulase-negative \u003cem\u003eStaphylococci\u003c/em\u003e (n\u0026thinsp;=\u0026thinsp;19), followed by \u003cem\u003eStaphylococcus aureus\u003c/em\u003e (n\u0026thinsp;=\u0026thinsp;14) (Supplemental Table\u0026nbsp;1).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eRisk factors for AKD in patients with bacteremia\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e shows the results of univariable and multivariable logistic regression analyses for AKD (with or without AKI) development. In multivariable analysis adjusting for intensive care unit onset, glycopeptide exposure, and white blood cell count, younger age (odds ratio [OR], 0.91; 95% confidence interval [CI], 0.83\u0026ndash;0.99; P\u0026thinsp;=\u0026thinsp;0.046) was associated with the development of AKD.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eUnivariate and multivariate logistic regression analyses of risk factors for AKD\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eUnivariate\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003eMultivariate\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOdds ratio\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e95%CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eOdds ratio\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e95%CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.84\u0026ndash;0.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.019\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.83\u0026ndash;0.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.046\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBody weight (per 1 kg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.93\u0026ndash;0.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.017\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimary disease of kidney disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.53\u0026ndash;21.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eICU onset\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.91\u0026ndash;6.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.61\u0026ndash;5.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.28\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGPC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.66\u0026ndash;3.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCRBSI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.47\u0026ndash;2.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUTI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.58\u0026ndash;9.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGlycopeptides\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.12\u0026ndash;6.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.026\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.56\u0026ndash;3.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.43\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhite blood cell (10\u003csup\u003e3\u003c/sup\u003e/\u0026micro;L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.91\u0026ndash;1.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.90\u0026ndash;1.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.12\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHemoglobin (g/dL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.84\u0026ndash;1.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlbumin (g/dL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.40\u0026ndash;1.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSeptic shock\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.60\u0026ndash;3.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003e95%CI, 95% confidence interval; \u003cem\u003eAKD\u003c/em\u003e, acute kidney diseases and disorders; \u003cem\u003eAKI\u003c/em\u003e, acute kidney injury; \u003cem\u003eCRBSI\u003c/em\u003e, catheter-related bloodstream infection; GPC, gram-positive cocci; \u003cem\u003eICU\u003c/em\u003e, intensive care unit; \u003cem\u003eUTI\u003c/em\u003e, urinary tract infection\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003e*Odds ratios for continuous variables are expressed per unit increase (e.g., per year for age).\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eRisk factors for AKD with AKI in patients with bacteremia\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e shows the analysis of risk factors for the development of AKD with AKI. This analysis compared AKD with AKI versus AKI without AKD (n\u0026thinsp;=\u0026thinsp;88) and excluded patients with AKD without AKI. In multivariable analysis, younger age (OR, 0.88 per year; 95% CI, 0.80\u0026ndash;0.97; P\u0026thinsp;=\u0026thinsp;0.018), primary kidney disease (OR, 10.3; 95% CI, 1.22\u0026ndash;112.0; P\u0026thinsp;=\u0026thinsp;0.036), UTI (OR, 7.22; 95% CI, 1.26\u0026ndash;50.0; P\u0026thinsp;=\u0026thinsp;0.031), and a lower albumin level (OR, 0.44 per 1 g/dL; 95% CI, 0.19\u0026ndash;0.92; P\u0026thinsp;=\u0026thinsp;0.037) were independently associated with the development of AKD with AKI.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eUnivariate and multivariate logistic regression analyses of risk factors for AKD with AKI\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eUnivariate\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003eMultivariate\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOdds ratio\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e95%CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eOdds ratio\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e95%CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.84\u0026ndash;0.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.046\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.80\u0026ndash;0.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.018\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBody weight (per 1 kg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.93\u0026ndash;0.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.041\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimary disease of kidney disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.67\u0026ndash;27.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e10.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.22\u0026ndash;112.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.036\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eICU onset\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.79\u0026ndash;6.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.90\u0026ndash;9.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.08\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGPC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.51\u0026ndash;2.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCRBSI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.44\u0026ndash;2.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUTI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.75\u0026ndash;11.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e7.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.26-50.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.031\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGlycopeptides\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.80\u0026ndash;4.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhite blood cell (10\u003csup\u003e3\u003c/sup\u003e/\u0026micro;L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.92\u0026ndash;1.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHemoglobin (g/dL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.79\u0026ndash;1.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlbumin (g/dL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.31\u0026ndash;1.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.19\u0026ndash;0.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.037\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSeptic shock\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.78\u0026ndash;4.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAKI stage\u0026thinsp;\u0026ge;\u0026thinsp;2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.54\u0026ndash;4.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAKI stage 3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.79\u0026ndash;69.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.045\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e8.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.98\u0026ndash;181.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.08\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003e95% CI, 95% confidence interval; \u003cem\u003eAKD\u003c/em\u003e, acute kidney diseases and disorders; \u003cem\u003eAKI\u003c/em\u003e, acute kidney injury; \u003cem\u003eCRBSI\u003c/em\u003e, catheter-related bloodstream infection; GPC, gram-positive cocci; \u003cem\u003eICU\u003c/em\u003e, intensive care unit; \u003cem\u003eUTI\u003c/em\u003e, urinary tract infection\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003eAnalysis was restricted to patients with AKD with AKI and those with AKI without AKD (n\u0026thinsp;=\u0026thinsp;88); AKD without AKI was excluded.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003e*Odds ratios for continuous variables are expressed per unit increase (e.g., per year for age).\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eKidney outcomes and mortality\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e shows the analysis of kidney outcomes and mortality. Compared with AKI without AKD (0/55), those with AKD group (with or without AKI) had significantly higher rates of death (6/41, 15%; P\u0026thinsp;=\u0026thinsp;0.005) and MAKE 30 (7/41, 17%; P\u0026thinsp;=\u0026thinsp;0.002) and MAKE90 (8/41, 20%; P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). All adverse outcomes occurred in the AKD with AKI subgroup.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eKidney outcome and mortality\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;96)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAKI without AKD \u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;55)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eAKD\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;41)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003eP value*\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAKD with\u003c/p\u003e \u003cp\u003eAKI\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;33)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAKD without AKI\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;8)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKRT during hospitalization\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.16\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCKD stage\u0026thinsp;\u0026ge;\u0026thinsp;3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.18\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDeath\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6 (18)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.005\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMAKE30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7 (7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7 (21)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMAKE90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8 (8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8 (24)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003eValues are expressed as numbers (%) or median [interquartile range]\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003e\u003cem\u003eAKI\u003c/em\u003e, acute kidney injury; \u003cem\u003eAKD\u003c/em\u003e, acute kidney diseases and disorders; \u003cem\u003eCKD\u003c/em\u003e, chronic kidney disease; \u003cem\u003eKRT\u003c/em\u003e, kidney replacement therapy; \u003cem\u003eMAKE30\u003c/em\u003e, major adverse kidney events at 30 days; \u003cem\u003eMAKE90\u003c/em\u003e, major adverse kidney events at 90 days;\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003e* P values compare AKI without AKD (=\u0026thinsp;55) versus AKD (with or without AKI, n\u0026thinsp;=\u0026thinsp;41).\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eSupplemental Table\u0026nbsp;2 summarizes the characteristics of eight patients with MAKE90 in the study cohort, revealing that all eight patients developed AKD and that most events were attributable to death, with several cases occurring in infants.\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this single-center, retrospective, observational study, we examined the frequency of AKD, clinical predictors of AKD development, and kidney outcomes and mortality among pediatric patients with BSI-associated kidney injury. In the study cohort, 41 patients (43%), including 8 (8%) who developed AKD without AKI, developed BSI-associated AKD. Logistic regression analysis revealed that younger age was an independent risk factor for BSI-associated AKD. Moreover, 2 patients progressed to CKD and 6 patients died, whereas 7 and 8 patients developed MAKE30 and MAKE90, respectively; all these patients had AKD with AKI. The rates of death, MAKE30, and MAKE90 were higher in patients with AKD than in those with AKI without AKD.\u003c/p\u003e \u003cp\u003eIn the present cohort, 43% of the patients with BSI-associated kidney dysfunction developed AKD. Pediatric data on AKD remain limited, and reported frequencies widely vary across clinical settings, reflecting differences in patient populations (including underlying diagnosis and illness severity), AKD ascertainment, and follow-up intensity (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e) [\u003cspan additionalcitationids=\"CR15 CR16 CR17 CR18 CR19 CR20 CR21 CR22 CR23 CR24 CR25 CR26 CR27\" citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. In BSI, sustained kidney dysfunction can reflect not only initial hemodynamic perturbations but also persistent inflammatory and immune-mediated injury affecting microcirculation, vascular endothelium, and tubular epithelium, with potential contribution from treatment-associated factors and difficulty in infection source control in device-associated infections [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan additionalcitationids=\"CR30\" citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eFrequency and outcome of pediatric patients with AKD\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStudy\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eClinical area\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN\u003c/p\u003e \u003cp\u003e(Overall)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAKD frequency\u003c/p\u003e \u003cp\u003en, (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eDenominator definition\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eMortality\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eIncident CKD\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDaraskevicius et al., 2020\u003csup\u003e14\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAllogeneic HSCT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18/51 (35%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePediatric allogeneic HSCT recipients\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eAKD 17% vs no AKD 3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLoBasso et al., 2022\u003csup\u003e15\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCardiac surgery (CPB/PICU)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3620\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e44/701 (3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eChildren with AKI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eHR 3.7 (95%CI 1.7\u0026ndash;7.9) /non-AKI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNamazzi et al., 2022\u003csup\u003e16\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSevere malaria\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e598\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e72/462 (16%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eChildren with severe malaria\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eAKD 9.7% vs no AKD 2.6%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDeng et al., 2022\u003csup\u003e17\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHospitalized pediatric AKI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e990\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e419/990 (42%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eChildren with AKI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eAKD stage2-3 vs stage0-1,\u003c/p\u003e \u003cp\u003e3-fold (on day 30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eAKD stage 2\u0026ndash;3 0.5% vs stage 0\u0026ndash;1 3%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePatel et al., 2022\u003csup\u003e18\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNon-kidney solid organ transplant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e338\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e44/338 (13%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eChildren undergoing\u003c/p\u003e \u003cp\u003enon-kidney solid organ transplantation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eOR 29.74 (95%CI 11.22\u0026ndash;78.82)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHui et al., 2023\u003csup\u003e19\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePICU admissions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e254\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14/25 (56%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eChildren who stayed in PICU for \u0026ge;\u0026thinsp;7 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eRR 7.2 (95%CI 0.4\u0026ndash;121.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePatel et al., 2023\u003csup\u003e20\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHospitalized AKI cohort\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e528\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e297/528 (56%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eChildren with AKI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eOR 4.77 (95%CI 3.0-7.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eOR 4.0 (95%CI 2.2\u0026ndash;7.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBatte et al., 2023\u003csup\u003e21\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSickle cell anemia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e185\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e129/185 (70%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eChildren with sickle cell anemia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eOR 2.01 (95%CI 1.08\u0026ndash;3.83)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMurdeshwar et al., 2023\u003csup\u003e22\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNephrology clinic/PICU mix AKI cohort\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5710\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e200/5710 (4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eChildren with AKI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e19%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e16%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eXu et al., 2024\u003csup\u003e23\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGeneral hospitalized population\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2346\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e279/1685 (16%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHospitalized pediatric patients\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eAKD with AKI 6.9% vs AKD without AKI 1.5% vs AKI without AKD 5.6%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChisavu et al., 2024\u003csup\u003e24\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHospitalized AKI cohort\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e736\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e125/736 (17%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eChildren with AKI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eOR 2.65 (95%CI 1.38\u0026ndash;5.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eOR 22.96 (95%CI 2.38-220.98)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNishi et al., 2025\u003csup\u003e25\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNeonatal AKI (NICU)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e280\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e85/280 (30%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNeonates with AKI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eAKD 8% vs no AKD 2%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eAKD 11% vs no AKD 5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlyahyawi et al., 2025\u003csup\u003e26\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDKA / T1D\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e373\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e131/299 (44%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eChildren with DKA who developed AKI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKarmakar et al., 2025\u003csup\u003e27\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePICU AKI cohort\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e390\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e38/57 (67%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eChildren with AKI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eAKD 42% vs no AKD 12%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eAKD 38% vs no AKD 6%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMauroner et al., 2025\u003csup\u003e28\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCritically ill children (PICU)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5922\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1199/5922 (20%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eChildren admitted to the PICU\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eAKD 2% vs no AKD 1.1%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eAKD 24% vs no AKD 2.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePresent study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBacteremia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1427\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e41/96 (43%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eChildren with bacteremia who developed kidney dysfunction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eAKD with AKI 18% vs AKD without AKI 0% vs AKI without AKD 0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eAKD with AKI 6% vs\u003c/p\u003e \u003cp\u003eAKD without AKI 0% vs AKI without AKD 0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003e\u003cem\u003eAKD\u003c/em\u003e, acute kidney disease; \u003cem\u003eAKI\u003c/em\u003e, acute kidney injury; \u003cem\u003eDKA\u003c/em\u003e, diabetic ketoacidosis; \u003cem\u003eHSCT\u003c/em\u003e, hematopoietic stem cell transplantation; \u003cem\u003eNA\u003c/em\u003e, not available; \u003cem\u003ePICU\u003c/em\u003e, pediatric intensive care unit; T1D, diabetes mellitus type 1\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eNotably, 8% of the overall cohort (20% of patients with AKD) met the AKD criteria without fulfilling the AKI criteria during the first 7 days. This AKD without AKI phenotype has been increasingly recognized in adult populations [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e], but pediatric evidence remains scarce. AKD can develop even in some cases where AKI is not detected early after BSI. Due to the small number of patients with AKD without AKI in the present study, larger pediatric studies are warranted to confirm our findings. In the present study cohort, compared with AKD with concomitant AKI, AKD without AKI tended to be associated with gram-positive cocci infection and glycopeptide use and was associated with lower C-reactive protein levels, suggesting heterogeneity in underlying mechanisms. The phenotype of AKD without AKI may be influenced less by the intrinsic severity of bacteremia and more by post-BSI management factors, including antimicrobial exposure and supportive care.\u003c/p\u003e \u003cp\u003eOur analyses revealed younger age as an independent predictor of BSI-associated AKD. Younger children may have limited renal functional reserve and greater vulnerability to hemodynamic stress and treatment exposure during severe infection, all of which can predispose to delayed renal recovery beyond day 7. We also assessed risk factors for AKD in the overall cohort and among patients with AKI, including those with and without AKD, to characterize the determinants of the phenotype of AKD with AKI. In the multivariable analysis restricted to patients with AKI, younger age, underlying kidney disease, UTI as the presumed source of bacteremia, and lower serum albumin levels were independently associated with the phenotype of AKD with AKI. Pediatric studies have consistently shown that greater AKI severity and persistence are key determinants of AKD, whereas intrinsic kidney disease has also been implicated as a high-risk substrate for incomplete renal recovery [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Our findings are broadly concordant with these observations, while additionally suggesting that infection source and host vulnerability, reflected by hypoalbuminemia, contribute to delayed recovery in pediatric patients with BSI. GPCs, particularly \u003cem\u003eStaphylococcus aureus\u003c/em\u003e, have been associated with an increased risk of AKI [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. However, we did not observe a significant association between GPCs and AKD in our cohort. Although often reported as a strong predictor of AKD [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], stage 3 AKI was not a statistically significant factor in our cohort, likely due to the limited power and overlap with other severity-related covariates.\u003c/p\u003e \u003cp\u003ePediatric studies consistently show that AKD is associated with worse outcomes, including higher mortality and a greater risk of incident CKD (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e). In the present study, adverse outcomes, including MAKE30 and MAKE90, were observed exclusively among patients who developed AKD. Although the small number of events in our cohort precluded robust risk modeling for MAKE endpoints and mortality, the direction of the association is consistent with previous reports [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Importantly, these findings should be interpreted with caution because death may act as a competing outcome and AKD may also be an indicator of overall illness severity rather than a direct causal mediator. In our cohort, deaths were attributable to systemic complications, such as multiple organ failure and pneumonia, hindering our ability to determine whether BSI-associated AKD independently contributed to mortality. Nonetheless, persistent kidney dysfunction after severe infection may plausibly reflect sustained microcirculatory dysfunction and inflammatory/tubular injury, which are linked to both AKD and adverse outcomes. Larger multicentre studies are warranted to clarify the independent prognostic impact of BSI-associated AKD and its relationship with MAKE and subsequent CKD. Further research should also investigate the association between BSI-associated AKD and mortality.\u003c/p\u003e \u003cp\u003eThis study had several limitations. First, SCr measurements were not standardized, given the retrospective study design. Nevertheless, SCr levels were frequently monitored during the first week after the index day, with a median of seven measurements. Second, data on cystatin C and kidney injury biomarkers, such as L-type fatty acid-binding protein and neutrophil gelatinase-associated lipocalin, were unavailable in this retrospective study. Third, management of bacteremia was not standardized, although the same infectious disease team reviewed antimicrobial selection and duration in most patients. Finally, multivariable modeling could not be performed with death or MAKE as endpoints, given that no such events occurred in patients without AKD, resulting in insufficient outcome variation for reliable estimation.\u003c/p\u003e \u003cp\u003eIn conclusion, in the present single-center cohort of pediatric patients with BSI and kidney dysfunction, AKD occurred in a substantial proportion, including a small subgroup of patients who developed AKD without meeting the AKI criteria. Younger age was independently associated with AKD development, and adverse outcomes occurred only among those with AKD. These findings support the importance of structured kidney follow-up during the first 7\u0026ndash;90 days after BSI-associated kidney injury and warrant confirmation in larger multicentre studies.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments:\u003c/strong\u003e We thank Enago (Crimson Interactive Pvt. Ltd.) for English language editing. We used ChatGPT (OpenAI) to assist with language editing; all outputs were reviewed and edited by the authors, who take full responsibility for the content.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest statement:\u0026nbsp;\u003c/strong\u003eKoichi Kamei has received research funding from the Public Foundation of Vaccination Research Center and the Taiju Life Social Welfare Foundation; donations from Chugai Pharmaceutical Co. Ltd., Teijin Pharma Ltd., Kyowa Kirin Co. Ltd., Shionogi \u0026amp; Co. Ltd., Daiichi Sankyo Co. Ltd., Mitsubishi Tanabe Pharma Co. Ltd, and Otsuka Pharmaceutical Co. Ltd.; and lecture fees from Terumo Co. Ltd., Baxter Ltd., and Zenyaku Kogyo Co., Ltd. Other authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e We did not receive any external funding for this study.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eData availability statement:\u003c/strong\u003e The datasets generated and/or analyzed during the current study are not publicly available due to ethical restrictions and institutional policies but are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eEthics approval\u003c/strong\u003e: This study was approved by the Ethics Committee of the National Center for Child Health and Development (approval no. 2023-298). The requirement for informed consent was waived due to the retrospective study design.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions:\u003c/strong\u003e MA prepared the first draft of the manuscript and performed data collection and analysis. TM contributed to data collection and provided infectious disease-related clinical input. HC contributed to data collection. SO, TK, MO, NT, KT, KI, SM, and KK edited and reviewed the manuscript for intellectual content. KN contributed to the study conception and methodology, performed and supervised the data analysis, and critically revised the manuscript as the corresponding author. All authors reviewed and approved the final manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eLameire NH, Levin A, Kellum JA et al (2021) Harmonizing acute and chronic kidney disease definition and classification: report of a Kidney Disease: Improving Global Outcomes (KDIGO) Consensus Conference. Kidney Int 100:516\u0026ndash;526. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.kint.2021.06.028\u003c/span\u003e\u003cspan address=\"10.1016/j.kint.2021.06.028\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChu R, Li C, Wang S, Zou W, Liu G, Yang L (2014) Assessment of KDIGO definitions in patients with histopathologic evidence of acute renal disease. 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Clin Microbiol Infect 30:1270\u0026ndash;1275. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi:10.1016/j.cmi.2024.06.017\u003c/span\u003e\u003cspan address=\"https://doi:10.1016/j.cmi.2024.06.017\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"pediatric-nephrology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pnep","sideBox":"Learn more about [Pediatric Nephrology](http://link.springer.com/journal/467)","snPcode":"467","submissionUrl":"https://www.editorialmanager.com/pnep/default2.aspx","title":"Pediatric Nephrology","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"acute kidney injury, acute kidney disease, bacteremia, pediatric, sepsis","lastPublishedDoi":"10.21203/rs.3.rs-9332681/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9332681/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground and hypothesis:\u003c/h2\u003e \u003cp\u003ePediatric acute kidney diseases and disorders (AKD) are a new concept defined as kidney damage lasting 7\u0026ndash;90 days from onset. Data on AKD after bloodstream infection are limited.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis single-center, retrospective observational study included patients aged\u0026thinsp;\u0026lt;\u0026thinsp;20 years with BSI who were subsequently diagnosed with acute kidney injury (AKI) and/or AKD between 1 May 2013 and 31 May 2023. The index day was the date of the first positive blood culture. AKI (days 0\u0026ndash;7) and AKD (days 7\u0026ndash;90) were defined according to the Kidney Disease: Improving Global Outcomes/Acute Disease Quality Initiative criteria. Patients were categorized as those with AKI without AKD, AKD with AKI, and AKD without AKI. Primary comparisons included AKD (with/without AKI) versus AKI without AKD. Logistic regression analyses were conducted to identify predictors of AKD.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eAmong 1427 patients with positive blood cultures, 197 developed kidney dysfunction. The final cohort comprised 96 patients, including 41 patients (43%) who developed AKD. In the final cohort, 55 patients had AKI without AKD, 33 patients had AKD with AKI, and 8 patients had AKD without AKI. By multivariable logistic regression analysis, younger age (odds ratio, 0.91; 95% confidence interval, 0.84\u0026ndash;0.99; P\u0026thinsp;=\u0026thinsp;0.046) was independently associated with AKD after adjusting for intensive care unit onset, glycopeptide exposure, and white blood cell count. Compared with AKI without AKD (0/55), those with AKD (with/without AKI) had higher rates of death (6/41, 15%) and major adverse kidney events at days 30 (7/41, 17%) and 90 (8/41, 20%). All adverse outcomes occurred in the AKD with AKI subgroup.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eIn children with bloodstream infection-associated kidney dysfunction, AKD occurred in a substantial proportion, including those not meeting the AKI criteria. Younger age was associated with AKD development.\u003c/p\u003e","manuscriptTitle":"Acute kidney diseases and disorders in children with bloodstream infection: frequency, predictors, and outcomes","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-20 17:02:04","doi":"10.21203/rs.3.rs-9332681/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"","date":"2026-04-13T14:15:16+00:00","index":0,"fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-13T12:28:42+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-04-10T06:50:21+00:00","index":"","fulltext":""},{"type":"submitted","content":"Pediatric Nephrology","date":"2026-04-06T06:21:47+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"pediatric-nephrology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pnep","sideBox":"Learn more about [Pediatric Nephrology](http://link.springer.com/journal/467)","snPcode":"467","submissionUrl":"https://www.editorialmanager.com/pnep/default2.aspx","title":"Pediatric Nephrology","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"d40ed52e-aa6b-43ea-80ec-1b57ad08b4d5","owner":[],"postedDate":"April 20th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-20T17:02:05+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-20 17:02:04","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9332681","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9332681","identity":"rs-9332681","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}