BackgroundSingle-center studies suggest that neonatal acute kidney injury (AKI)
is associated with poor outcomes. However, inferences regarding the
association between AKI, mortality, and hospital length of stay are limited
due to the small sample size of those studies. In order to determine whether
neonatal AKI is independently associated with increased mortality and longer
hospital stay, we analyzed the Assessment of Worldwide Acute Kidney
Epidemiology in Neonates (AWAKEN) database.MethodsAll neonates admitted to 24 participating neonatal intensive care
units from four countries (Australia, Canada, India, United States) between
January 1 and March 31, 2014, were screened. Of 4273 neonates screened, 2022
(47·3%) met study criteria. Exclusion criteria included: no
intravenous fluids ≥48 hours, admission ≥14 days of life,
congenital heart disease requiring surgical repair at <7 days of life,
lethal chromosomal anomaly, death within 48 hours, inability to determine
AKI status or severe congenital kidney abnormalities. AKI was defined using
a standardized definition —i.e., serum creatinine rise of
≥0.3 mg/dL (26.5 mcmol/L) or ≥50% from previous
lowest value, and/or if urine output was <1 mL/kg/h on postnatal days 2
to 7.FindingsIncidence of AKI was 605/2022 (29·9%). Rates varied
by gestational age groups (i.e., ≥22 to <29 weeks
=47·9%; ≥29 to <36 weeks
=18·3%; and ≥36 weeks
=36·7%). Even after adjusting for multiple potential
confounding factors, infants with AKI had higher mortality compared to those
without AKI [(59/605 (9·7%) vs. 20/1417
(1·4%); p< 0.001; adjusted OR=4·6
(95% CI=2·5–8·3);
p=<0·0001], and longer hospital stay
[adjusted parameter estimate 8·8 days (95%
CI=6·1–11·5);
p<0·0001].InterpretationNeonatal AKI is a common and independent risk factor for mortality
and longer hospital stay. These data suggest that neonates may be impacted
by AKI in a manner similar to pediatric and adult patients.FundingUS National Institutes of Health, University of Alabama at
Birmingham, Cincinnati Children’s, University of New Mexico.
Background:
Neonates with serum creatinine (SCr) rise ≥ 0.3 mg/dL and/or 50% SCr rise are more likely to die, even when controlling for confounders. These thresholds have not been tested in newborns. We hypothesized that different gestational age (GA) groups require different SCr thresholds.
Methods:
Neonates in Assessment of Worldwide Acute Kidney Epidemiology in Neonates (AWAKEN) with ≥1 SCr on postnatal days 1–2 and ≥1 SCr on postnatal days 3–8 were assessed. We compared the mortality predictability of SCr absolute (≥0.3 mg/dL) vs percent (≥50%) rise. Next, we determine usefulness of combining absolute with percent rise. Finally, we determined the optimal absolute, percent, and maximum SCr thresholds that provide the highest mortality area under curve (AUC) and specificity for different GA groups.
Results:
The ≥0.3 mg/dL rise outperformed ≥50% SCr rise. Addition of percent rise did not improve mortality predictability. The optimal SCr thresholds to predict AUC and specificity were ≥0.3 & ≥0.6 mg/dL for ≤29 weeks GA, and ≥0.1 & ≥0.3 mg/dL for >29 week GA. The maximum SCr value provides great specificity.
Conclusion:
Unique SCr rise cutoffs for different GA improves outcome prediction. Percent SCr rise does not add value to the neonatal AKI definition.
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