Prevalence of Arginine Vasopressin Deficiency among Children and Adolescents Declared Dead by Neurologic Criteria.

Abstract

To determine the prevalence of arginine vasopressin deficiency (AVP-D) in children and adolescents declared brain dead (BD)/death by neurologic criteria (DNC) and to evaluate the association between cause of brain injury and the development of AVP-D. We retrospectively analyzed 53 pediatric BD/DNC patients ages 0-21 years from 2013 to 2023 at a single tertiary children's hospital to assess the prevalence of AVP-D and compare those patients with and without AVP-D. AVP-D frequency by injury mechanism (anoxic brain injury, traumatic brain injury, malignancy) was also analyzed. Of the 53 patients declared BD/DNC, 47 (88.7%, 95% CI 77.9% to 95.3%) were diagnosed with AVP-D. The prevalence of AVP-D was similar according to the cause of brain injury (84.4%, 100.0%, and 92.3% for anoxic brain injury, traumatic brain injury, and brain tumor, respectively; P = .410). Clinical characteristics and length of stays were similar between AVP-D and non-AVP-D groups. The estimated glomerular filtration rate (mL/min/1.73 m²) was lower in children without AVP-D (78 [51-165] vs 178 [133-253]; P = .009). The prevalence of AVP-D is high in children and adolescents declared BD/DNC, and it is not significantly different based on the cause of BD/DNC. The absence of AVP-D was associated with reduced renal function. Additional multicenter studies are needed to assess clinical characteristics and renal function with preserved neuroendocrine function in children with BD/DNC.