Blood Transfusion in Pediatric Sepsis-Associated Acute Kidney Injury: A Nationwide Study of Risk Factors and Outcomes

Objective To identify the predictors of blood transfusion in children with sepsis-related acute kidney injury through a nationwide database analysis. Methods Data from the Nationwide Inpatient Sample (NIS) database were retrospectively reviewed to examine pediatric patients diagnosed with sepsis-associated acute kidney injury (SA-AKI) from 2010 to 2019. Patients were divided into two cohorts: those who received blood transfusions and those who did not. Demographic, hospital, comorbidity, and complication data were compared between the two cohorts. Subsequently, univariate and multivariate logistic regression analyses were performed to identify factors associated with blood transfusion in children with SA-AKI. Results The study encompassed a total of 7,521 pediatric patients diagnosed with SA-AKI. Of these, 2,269 patients received blood transfusions, constituting 30.17% of the total cohort. The median age of patients in the transfusion group was 4 years (range: 0–12 years), while the median age in the non-transfusion group was 8 years (range: 1–15 years). Patients requiring blood transfusions exhibited significantly longer hospital stays, higher overall medical costs, and elevated in-hospital death rates ( p  < 0.05). Multivariate regression analysis revealed several independent predictors of blood transfusion, including acute respiratory failure, continuous mechanical ventilation, septic shock, anemia, coagulopathy, disseminated intravascular coagulation, lymphoma, thrombocytopenia, gastrointestinal bleeding, and hepatic insufficiency ( p  < 0.05). Conclusion Pediatric patients with SA-AKI who require blood transfusions experience heightened clinical complexity, increased resource utilization, and impose a greater economic burden on both families and society. A comprehensive understanding of the risk factors associated with transfusion enables healthcare providers to implement proactive measures and early interventions to mitigate the need for blood transfusions.