Journal Article

Identifying critically ill children at high risk of acute kidney injury and renal replacement therapy

Cunliffe, Nigel A., Jennings, Rebecca J., Paulus, Stephane, Newland, Paul, Broughton, Caroline, McGalliard, Rachel J., Jeffers, Graham, Maguire, Samuel, Jones, Caroline A., Baines, Paul, McWilliam, Stephen J., Carrol, Enitan D., Siner, Sarah, McColl, Lynsey, Lane, Steven, Peak, Matthew, Chesters, Christine

2020

Overview

Acute kidney injury (AKI), a common complication in paediatric intensive care units (PICU), is associated with increased morbidity and mortality. In this single centre, prospective, observational cohort study, neutrophil gelatinase-associated lipocalin in urine (uNGAL) and plasma (pNGAL) and renal angina index (RAI), and combinations of these markers, were assessed for their ability to predict severe (stage 2 or 3) AKI in children and young people admitted to PICU. In PICU children and young people had initial and serial uNGAL and pNGAL measurements, RAI calculation on day 1, and collection of clinical data, including serum creatinine measurements. Primary outcomes were severe AKI and renal replacement therapy (RRT). Secondary outcomes were length of stay, hospital acquired infection and mortality. The area under the Receiver Operating Characteristic (ROC) curves and Youden index was used to determine biomarker performance and identify optimum cut-off values. Of 657 children recruited, 104 met criteria for severe AKI (15∙8%) and 47 (7∙2%) required RRT. Severe AKI was associated with increased length of stay, hospital acquired infection, and mortality. The area under the curve (AUC) for severe AKI prediction for Day 1 uNGAL, Day 1 pNGAL and RAI were 0.75 (95% Confidence Interval [CI] 0∙69, 0∙81), 0∙64 (95% CI 0∙56, 0∙72), and 0.73 (95% CI 0∙65, 0∙80) respectively. The optimal combination of measures was RAI and day 1 uNGAL, giving an AUC of 0∙80 for severe AKI prediction (95% CI 0∙71, 0∙88). In this heterogenous PICU cohort, urine or plasma NGAL in isolation had poorer prediction accuracy for severe AKI than in previously reported homogeneous populations. However, when combined together with RAI, they produced good prediction for severe AKI.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Acute kidney failure / Acute Kidney Injury - metabolism / Acute Kidney Injury - mortality / Acute Kidney Injury - therapy / Adolescent / Angina / Angina pectoris / Biology and Life Sciences / Biomarkers / Care and treatment / Child / Child, Preschool / Children / Confidence intervals / Creatinine / Critical care / Critical Illness - epidemiology / Critical Illness - mortality / Critically ill children / Female / Gelatinase / Health risks / Hospitals / Humans / Infant / Infant, Newborn / Infections / Intensive care units / Intensive Care Units, Pediatric / Kidney diseases / Kidneys / Length of Stay / Lipocalin / Lipocalin-2 - blood / Lipocalin-2 - urine / Male / Medicine and Health Sciences / Methods / Morbidity / Mortality / Nosocomial infections / Observational studies / Optimization / Pediatrics / Peritoneal dialysis / Predictions / Prospective Studies / Renal replacement therapy / Renal Replacement Therapy - methods / Risk factors / Tertiary Care Centers / Treatment Outcome / Urine / Young adults