Pediatric Reference Change Value Optimized for Acute Kidney Injury: Multicenter Retrospective Study in China

Abstract

The standard definition of pediatric acute kidney injury (AKI) is evolving, especially for critically ill in the PICU. We sought to validate the application of the Pediatric Reference Change Value Optimized for Acute Kidney Injury in Children (pROCK) criteria in critically ill children. DESIGN: Multicenter retrospective study.SETTING: Six PICUs in mainland China. PATIENTS:One thousand six hundred seventy-eight hospitalized children admitted to the PICU with at least two creatinine values within 7 days. INTERVENTIONS: None.MEASUREMENTS AND MAIN RESULTS: AKI was diagnosed and staged according to the Pediatric Risk, Injury, Failure, Loss, End-Stage Renal Disease (pRIFLE), the Kidney Disease Improving Global Outcomes (KDIGO), and the pROCK criteria. Multiple clinical parameters were assessed and analyzed along with 90-day follow-up outcomes. According to the definitions of pRIFLE, KDIGO, and pROCK, the prevalence of AKI in our cohort of 1,678 cases was 52.8% (886), 39.0% (655), and 19.0% (318), respectively. The presence of AKI, as defined by pROCK, was associated with increased number of injured organs, occurrence of sepsis, use of mechanical ventilation, use of continuous renal replace therapy (p < 0.05), higher Pediatric Risk of Mortality III score, and higher Pediatric Logistic Organ Dysfunction-2 score (p < 0.001). The survival curve of 90-day outcomes showed that pROCK was associated with shorter survival time (LogRank p < 0.001), and pROCK definition was associated with better separation of the different stages of AKI from non-AKI (p < 0.001). CONCLUSIONS:In this retrospective analysis of AKI criteria in PICU admissions in China, pROCK is better correlated with severity and outcome of AKI. Hence, the pROCK criteria for AKI may have better utility in critically ill children.

Comparison of diagnostic criteria for sepsis-associated acute kidney injury in the pediatric intensive care unit: a retrospective cohort study

“…It is necessary to closely monitor the major changes of kidney-related indicators during treatment in order to achieve early diagnosis and treatment. This conclusion is consistent with other related study ( 18 ). The incidence of SA-AKI in children and mortality rate (3/62) in the pRIFLE group were the highest.…”

“…The incidence and specificity of the three standards in this study also diverged. The incidence of SA-AKI in the pROCK group (35/62, 56.5%) was lower than that in the other two groups, indicating that pROCK may have higher specificity for diagnosing SA-AKI and may help reduce overdiagnosis, which is consistent with the findings of Zeng et al ( 18 ). In this study, the critical scores of children in the pROCK group, especially the PRISM score, was significantly higher than that in other two groups.…”

Measurement Error

“…A recent multicenter retrospective study compared the pROCK criteria to the pRIFLE and KDIGO definitions of AKI in a correlation with severity of illness and outcome of AKI (18). The study found that, by accounting for the inherent variability in serum creatinine measurements, AKI as defined by the pROCK criteria was associated with increased morbidity, including sepsis use of mechanical ventilation or continuous renal replacement, and increased mortality.…”

“…Compared with the “Pediatric Risk, Injury, Failure, Loss, End-Stage Renal Disease” (pRIFLE) and the “Kidney Disease Improving Global Outcomes” (KDIGO) definitions of AKI, in which a patient could be diagnosed with AKI based on percentage increases in serum creatinine alone, the pROCK definition requires both an increase in serum creatinine by 30% from baseline as well as an absolute increase of at least 20 µmol/L, the analyte’s RCV. A recent multicenter retrospective study compared the pROCK criteria to the pRIFLE and KDIGO definitions of AKI in a correlation with severity of illness and outcome of AKI (18). The study found that, by accounting for the inherent variability in serum creatinine measurements, AKI as defined by the pROCK criteria was associated with increased morbidity, including sepsis use of mechanical ventilation or continuous renal replacement, and increased mortality.…”

Acute Kidney Injury in Neonatal Intensive Care Unit: Epidemiology, Diagnosis and Risk Factors

“…Furthermore, the pROCK criteria have been applied to critically ill children for AKI detection, revealing that, at ICU admission, this method better correlated with the severity and outcome of AKI if compared to pRIFLE and KDIGO definitions [ 14 ].…”