Assessment of a renal angina index for prediction of severe acute kidney injury in critically ill children: a multicentre, multinational, prospective observational study

Autor: Rajit K Basu, Ahmad Kaddourah, Stuart L Goldstein, Ayse Akcan-Arikan, Megan Arnold, Cody Cruz, Michele Goldsworthy, Nancy Jaimon, Stephen Alexander, Marino Festa, Deirdre Hahn, Lauren Brown, Ari Jeon, Akash Deep, David Askenazi, Sean Bagshaw, Catherine Morgan, Rashid Alobaidi, Rajit Basu, David Cooper, Stuart Goldstein, Theresa Mottes, Tara Terrell, Patricia Arnold, Christina Metcalf, Shalayna Woodley, Radovan Bogdanović, Natasa Stajić, Branko Kovacevic, Amira Peco-Antic, Aleksandra Paripovic, Patrick Brophy, Timothy Bunchman, Duane Williams, Michelle Hoot, Vimal Chadha, Keefe Davis, Vikas Dharnidharka, Leslie Walther, Vincent Faustino, Janet Taft, Joana Tala, Katja Gist, Danielle Soranno, Il Soo Ha, Hee Gyung Kang, Richard Hackbarth, Mary Avendt-Reeber, Chloe Butler, Doug DeGraaf, Dawn Eding, Nathalie Hautala, Akunne Ndika, Eka Laksmi Hidayati, Songming Huang, Sean Kennedy, Madeleine Didsbury, Hari Kushartono, Risky Prasetyo, Cherry Mammen, Matthew Paden, Cheryl Stone, Stefano Picca, Federica Connola, James Schneider, Todd Sweberg, Aaron Kessel, David Selewski, Susan Hieber, Brankica Spasojević-Dimitrijeva, Ivana Ivanisevic, Jovana Putnik, Snezana Ristic, Scott Sutherland, Amy Staples, Craig Wong, Senan Hadid, Catherine Joseph, Robert Woroniecki, Michael Zappitelli, Noha Elsaerafy, Joshua Zaritsky
Jazyk: angličtina
Rok vydání: 2018
Předmět:
Popis: Summary Background Acute kidney injury occurs in one in four children admitted to an intensive care unit (ICU) and its severity is independently associated with increased patient morbidity and mortality. Early prediction of acute kidney injury has the potential to improve outcomes. In smaller, single-centre trial populations, we have previously derived and validated the performance of a renal angina index, a context-driven risk stratification system, to predict severe acute kidney injury in children and adolescents. Here, we tested the predictive accuracy of this index for severe acute kidney injury in a large heterogeneous population. Methods We did a prospective, observational study (AWARE) that recruited patients in the ICUs of 32 hospitals in nine countries across Asia, Australia, Europe, and North America. All patients aged between 3 months and 25 years who were admitted to an ICU at least 48 h previously were eligible. Exclusion criteria were a history of stage 5 chronic kidney disease (ie, estimated glomerular filtration rate 2 or on maintenance dialysis) or kidney transplantation in the preceding 90 days. Patients' medical records were reviewed to collect data up to 3 months before (serum creatinine only), daily during the first 7 days, and on day 28 after ICU admission. For the assessment of the renal angina index, we included patients from the AWARE study who had full data from the day of ICU admission, day 3, and day 28, including serum creatinine concentrations and urine output measurements. The primary outcome was the presence of severe acute kidney injury (stage 2–3 acute kidney injury, according to Kidney Disease Improving Global Outcomes [KDIGO] guidelines) on the third day after ICU admission. We compared the performance of the renal angina index with changes in serum creatinine relative to baseline for prediction of the primary outcome. A score of eight points or more on the renal angina index defined fulfilment of renal angina; serum creatinine concentration relative to baseline was calculated using maximum serum creatinine concentration in the first 12 h of ICU admission). This trial is registered with ClinicalTrials.gov, number NCT01987921. Findings Between Jan 1 and Dec 31, 2014, we obtained data for 1590 patients. 286 patients (18%) had fulfilment of renal angina. At day 3, severe acute kidney injury occurred in 121 (42%) patients positive for renal angina and 247 (19%) patients negative for renal angina (relative risk [RR] 2·23, 95% CI 1·87–2.66, p vs 18 [2%], p vs 53 [4%], p=0·01). Fulfilment of renal angina showed better prediction for severe acute kidney injury than serum creatinine greater than baseline (RR 1.61, 95% CI 1·33–1·93; p vs serum creatinine greater than baseline 0·68, 0·49–4·94). Interpretation Earlier and better prediction of severe acute kidney injury has the potential to improve patient outcomes associated with acute kidney injury. Compared with isolated, context-free changes in serum creatinine, renal angina risk assessment improved accuracy for prediction of severe acute kidney injury in critically ill children and young people. Funding US National Institutes of Health.
Databáze: OpenAIRE
Externí odkaz: