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Acute kidney injury is an independent risk factor for pediatric intensive care unit mortality, longer length of stay and prolonged mechanical ventilation in critically ill children: a two-center retrospective cohort study.
Crit Care. 2011 Jun 10; 15(3):R146.CC

Abstract

INTRODUCTION

In adults, small (< 50%) serum creatinine (SCr) increases predict mortality. It is unclear whether different baseline serum creatinine (bSCr) estimation methods affect findings of acute kidney injury (AKI)-outcome associations. We characterized pediatric AKI, evaluated the effect of bSCr estimation approaches on AKI-outcome associations and evaluated the use of small SCr increases to predict AKI development.

METHODS

We conducted a retrospective cohort database study of children (excluding postoperative cardiac or renal transplant patients) admitted to two pediatric intensive care units (PICUs) for at least one night in Montreal, QC, Canada. The AKI definition was based on the Acute Kidney Injury Network staging system, excluding the requirement of SCr increase within 48 hours, which was impossible to evaluate on the basis of our data set. We estimated bSCr two ways: (1) the lowest SCr level in the three months before admission or the average age- and gender-based norms (the standard method) or (2) by using average norms in all patients. Outcomes were PICU mortality and length of stay as well as required mechanical ventilation. We used multiple logistic regression analysis to evaluate AKI risk factors and the association between AKI and mortality. We used multiple linear regression analysis to evaluate the effect of AKI on other outcomes. We calculated diagnostic characteristics for early SCr increase (< 50%) to predict AKI development.

RESULTS

Of 2,106 admissions (mean age ± SD = 5.0 ± 5.5 years; 47% female), 377 patients (17.9%) developed AKI (using the standard bSCr method) during PICU admission. Higher Pediatric Risk of Mortality score, required mechanical ventilation, documented infection and having a bSCr measurement were independent predictors of AKI development. AKI was associated with increased mortality (adjusted odds ratio (OR) = 3.7, 95% confidence interval (95% CI) = 2.1 to 6.4, using the standard bSCr method; OR = 4.5, 95% CI = 2.6 to 7.9, using normative bSCr values in all patients). AKI was independently associated with longer PICU stay and required mechanical ventilation. In children with no admission AKI, the initial percentage SCr increase predicted AKI development (area under the curve = 0.67, 95% CI = 0.60 to 0.74).

CONCLUSIONS

AKI is associated with increased mortality and morbidity in critically ill children, regardless of the bSCr used. Paying attention to small early SCr increases may contribute to early AKI diagnosis in conjunction with other new AKI biomarkers.

Authors+Show Affiliations

Division of Nephrology, Department of Pediatrics, McGill University Health Centre, Montreal Children's Hospital, 2300 Tupper, Room E-213, Montreal, QC, H3H 1P3, Canada.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

21663616

Citation

Alkandari, Omar, et al. "Acute Kidney Injury Is an Independent Risk Factor for Pediatric Intensive Care Unit Mortality, Longer Length of Stay and Prolonged Mechanical Ventilation in Critically Ill Children: a Two-center Retrospective Cohort Study." Critical Care (London, England), vol. 15, no. 3, 2011, pp. R146.
Alkandari O, Eddington KA, Hyder A, et al. Acute kidney injury is an independent risk factor for pediatric intensive care unit mortality, longer length of stay and prolonged mechanical ventilation in critically ill children: a two-center retrospective cohort study. Crit Care. 2011;15(3):R146.
Alkandari, O., Eddington, K. A., Hyder, A., Gauvin, F., Ducruet, T., Gottesman, R., Phan, V., & Zappitelli, M. (2011). Acute kidney injury is an independent risk factor for pediatric intensive care unit mortality, longer length of stay and prolonged mechanical ventilation in critically ill children: a two-center retrospective cohort study. Critical Care (London, England), 15(3), R146. https://doi.org/10.1186/cc10269
Alkandari O, et al. Acute Kidney Injury Is an Independent Risk Factor for Pediatric Intensive Care Unit Mortality, Longer Length of Stay and Prolonged Mechanical Ventilation in Critically Ill Children: a Two-center Retrospective Cohort Study. Crit Care. 2011 Jun 10;15(3):R146. PubMed PMID: 21663616.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Acute kidney injury is an independent risk factor for pediatric intensive care unit mortality, longer length of stay and prolonged mechanical ventilation in critically ill children: a two-center retrospective cohort study. AU - Alkandari,Omar, AU - Eddington,K Allen, AU - Hyder,Ayaz, AU - Gauvin,France, AU - Ducruet,Thierry, AU - Gottesman,Ronald, AU - Phan,Véronique, AU - Zappitelli,Michael, Y1 - 2011/06/10/ PY - 2011/02/19/received PY - 2011/05/02/revised PY - 2011/06/10/accepted PY - 2011/6/14/entrez PY - 2011/6/15/pubmed PY - 2012/8/21/medline SP - R146 EP - R146 JF - Critical care (London, England) JO - Crit Care VL - 15 IS - 3 N2 - INTRODUCTION: In adults, small (< 50%) serum creatinine (SCr) increases predict mortality. It is unclear whether different baseline serum creatinine (bSCr) estimation methods affect findings of acute kidney injury (AKI)-outcome associations. We characterized pediatric AKI, evaluated the effect of bSCr estimation approaches on AKI-outcome associations and evaluated the use of small SCr increases to predict AKI development. METHODS: We conducted a retrospective cohort database study of children (excluding postoperative cardiac or renal transplant patients) admitted to two pediatric intensive care units (PICUs) for at least one night in Montreal, QC, Canada. The AKI definition was based on the Acute Kidney Injury Network staging system, excluding the requirement of SCr increase within 48 hours, which was impossible to evaluate on the basis of our data set. We estimated bSCr two ways: (1) the lowest SCr level in the three months before admission or the average age- and gender-based norms (the standard method) or (2) by using average norms in all patients. Outcomes were PICU mortality and length of stay as well as required mechanical ventilation. We used multiple logistic regression analysis to evaluate AKI risk factors and the association between AKI and mortality. We used multiple linear regression analysis to evaluate the effect of AKI on other outcomes. We calculated diagnostic characteristics for early SCr increase (< 50%) to predict AKI development. RESULTS: Of 2,106 admissions (mean age ± SD = 5.0 ± 5.5 years; 47% female), 377 patients (17.9%) developed AKI (using the standard bSCr method) during PICU admission. Higher Pediatric Risk of Mortality score, required mechanical ventilation, documented infection and having a bSCr measurement were independent predictors of AKI development. AKI was associated with increased mortality (adjusted odds ratio (OR) = 3.7, 95% confidence interval (95% CI) = 2.1 to 6.4, using the standard bSCr method; OR = 4.5, 95% CI = 2.6 to 7.9, using normative bSCr values in all patients). AKI was independently associated with longer PICU stay and required mechanical ventilation. In children with no admission AKI, the initial percentage SCr increase predicted AKI development (area under the curve = 0.67, 95% CI = 0.60 to 0.74). CONCLUSIONS: AKI is associated with increased mortality and morbidity in critically ill children, regardless of the bSCr used. Paying attention to small early SCr increases may contribute to early AKI diagnosis in conjunction with other new AKI biomarkers. SN - 1466-609X UR - https://www.unboundmedicine.com/medline/citation/21663616/Acute_kidney_injury_is_an_independent_risk_factor_for_pediatric_intensive_care_unit_mortality_longer_length_of_stay_and_prolonged_mechanical_ventilation_in_critically_ill_children:_a_two_center_retrospective_cohort_study_ L2 - https://ccforum.biomedcentral.com/articles/10.1186/cc10269 DB - PRIME DP - Unbound Medicine ER -