Pediatric Risk, Injury, Failure, Loss, End-Stage Renal Disease Score Identifies Acute Kidney Injury and Predicts Mortality in Critically Ill Children

Soler, Yadira A.; Nieves-Plaza, Mariely; Prieto, Monica Martinez; Jesús, Ricardo García-De; Suárez-Rivera, Marta

doi:10.1097/pcc.0b013e3182745675

Cited by 123 publications

(135 citation statements)

References 19 publications

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“…In our analysis, the association of any AKI with increased mortality persisted when accounting for severity of illness. Patients with any evidence of AKI had 3.4 times increased odds of ICU mortality in our study, consistent with previous reports put forth by Alkandari [10,11,14,22]. In summary, our data shows that the KDIGO criteria describe clinically relevant AKI in a broad pediatric critical care population.…”

Section: Discussionsupporting

confidence: 92%

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Validation of the KDIGO acute kidney injury criteria in a pediatric critical care population

et al. 2014

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Section: Discussionsupporting

confidence: 92%

“…Several studies have shown that AKI is associated with increased mortality, length of mechanical ventilation, and length of stay (LOS) in a broad spectrum of pediatric patients [1,[4][5][6][7][8][9][10][11][12].…”

Section: Introductionmentioning

confidence: 99%

Validation of the KDIGO acute kidney injury criteria in a pediatric critical care population

et al. 2014

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“…We also found that higher preoperative levels of CK-MB and h-FABP were associated with extended ICU and hospital LOS in addition to AKI, which is consistent with previous studies. [46][47][48][49] However, addition of AKI to these models did not attenuate the risk ratios, suggesting that the relationship between these biomarkers and extended LOS is mediated by factors other than AKI. These findings suggest that CK-MB and h-FABP may be superior to BNP in evaluating risk of postoperative AKI in children.…”

Section: Discussionmentioning

confidence: 99%

Cardiac Biomarkers and Acute Kidney Injury After Cardiac Surgery

et al. 2015

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OBJECTIVES: To examine the relationship of cardiac biomarkers with postoperative acute kidney injury (AKI) among pediatric patients undergoing cardiac surgery.METHODS: Data from TRIBE-AKI, a prospective study of children undergoing cardiac surgery, were used to examine the association of cardiac biomarkers (N-type pro-B-type natriuretic peptide, creatine kinase-MB [CK-MB], heart-type fatty acid binding protein [h-FABP], and troponins I and T) with the development of postoperative AKI. Cardiac biomarkers were collected before and 0 to 6 hours after surgery. AKI was defined as a $50% or 0.3 mg/dL increase in serum creatinine, within 7 days of surgery. RESULTS:Of the 106 patients included in this study, 55 (52%) developed AKI after cardiac surgery. Patients who developed AKI had higher median levels of pre-and postoperative cardiac biomarkers compared with patients without AKI (all P , .01). Preoperatively, higher levels of CK-MB and h-FABP were associated with increased odds of developing AKI (CK-MB: adjusted odds ratio 4.58, 95% confidence interval [CI] 1.56-13.41; h-FABP: adjusted odds ratio 2.76, 95% CI 1.27-6.03). When combined with clinical models, both preoperative CK-MB and h-FABP provided good discrimination (area under the curve 0.77, 95% CI 0.68-0.87, and 0.78, 95% CI 0.68-0.87, respectively) and improved reclassification indices. Cardiac biomarkers collected postoperatively did not significantly improve the prediction of AKI beyond clinical models.CONCLUSIONS: Preoperative CK-MB and h-FABP are associated with increased risk of postoperative AKI and provide good discrimination of patients who develop AKI. These biomarkers may be useful for risk stratifying patients undergoing cardiac surgery.WHAT'S KNOWN ON THIS SUBJECT: Acute kidney injury (AKI) occurs in up to 50% of children after cardiopulmonary bypass and is associated with adverse outcomes. Renal biomarkers have been shown to predict postoperative AKI, but few studies have examined cardiac biomarkers for risk classification.WHAT THIS STUDY ADDS: Preoperative levels of creatine kinase-MB and heart-type fatty acid binding protein are strongly associated with the development of postoperative AKI after pediatric cardiac surgery and can be used to improve preoperative clinical risk prediction.

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“…9 The justifi cation of frequent, costly SCr measurements is therefore diffi cult. Given the potential damage that is known from studies of AKI in adult and pediatric patients who did not examine nephrotoxin exposure specifi cally, 4,29,30 we believe more frequent measurement is indicated.…”

Section: Discussionmentioning

confidence: 99%

Administrative Data Misclassifies and Fails to Identify Nephrotoxin-Associated Acute Kidney Injury in Hospitalized Children

Schaffzin¹,

Dodd

Nguyen

et al. 2014

Hospital Pediatrics

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Objectives: Nephrotoxin exposure is a common cause of acute kidney injury (AKI) in hospitalized children. AKI detection relies on regular serum creatinine (SCr) screening among exposed patients. We sought to determine how well administrative data identify hospitalized noncritically ill children with nephrotoxic medication-associated AKI in the contexts of incomplete and complete screening. Methods: We conducted a single-center retrospective cohort study among noncritically ill hospitalized children. We compared administrative data sensitivity to that among a separate cohort for whom adequate screening was defined as daily SCr measurement. For the original cohort, nephrotoxin exposure was defined as exposure to ≥3 nephrotoxins at once or ≥3 days of aminoglycoside therapy. AKI was defined by the change in SCr (pediatric-modified Risk Injury Failure Loss End-Stage Renal Disease [pRIFLE] criteria) or discharge code. Adequate SCr screening was defined as 2 measurements obtained ≤96 hours apart. Administrative data and laboratory values were merged to compare AKI by discharge code and pRIFLE criteria. Results: 747 of 1472 (50.7%) nephrotoxin-exposed patients were adequately screened; 82 (11.0%) had AKI by pRIFLE criteria, 52 (7.0%) by discharge code. Sensitivity of nephrotoxin-associated AKI diagnosis by discharge code compared with pRIFLE criteria was 23.2% (95% confidence interval = 14.0–32.3). In the comparison cohort, 70 (26.8%) patients had AKI by pRIFLE criteria and 26 (10.0%) by discharge code; sensitivity was 21.4% (95% confidence interval = 11.8%–31.0%). Conclusions: pRIFLE criteria identified more patients than were identified by discharge code. Identifying patients with nephrotoxin-associated AKI by discharge code, even in the presence of complete AKI detection, underrepresents the true incidence of nephrotoxin-associated AKI in hospitalized children.

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Pediatric Risk, Injury, Failure, Loss, End-Stage Renal Disease Score Identifies Acute Kidney Injury and Predicts Mortality in Critically Ill Children

Cited by 123 publications

References 19 publications

Validation of the KDIGO acute kidney injury criteria in a pediatric critical care population

Validation of the KDIGO acute kidney injury criteria in a pediatric critical care population

Cardiac Biomarkers and Acute Kidney Injury After Cardiac Surgery

Administrative Data Misclassifies and Fails to Identify Nephrotoxin-Associated Acute Kidney Injury in Hospitalized Children

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