الفهرس | Only 14 pages are availabe for public view |
Abstract Acute kidney injury (AKI) is highly prevalent in PICU critically ill patients, leading to significant mortality and morbidity, reduced quality of life and high short- and long-term health-care costs. Early detection of AKI in critically ill children in an ICU setting is often a challenging situation as diagnosis is mainly based on clinical indications (oliguria/anuria) and/or rise of serum creatinine, which is a late phenomenon. In addition, fluid overload, use of nephrotoxic medications and need of mechanical ventilation often complicate the condition and contribute to mortality. Therefore, it becomes imperative to apply some other clinical (RAI) and biochemical marker (serum cystatin C) for early detection who is at risk or who are developing AKI so that they can be treated earlier or more intensively to limit subsequent problems as much as possible. The RAI has been validated in prediction for severe AKI, need of RRT, mechanical ventilation and mortality. The renal angina index was proposed to predict AKI in critically ill children on the basis of kidney injury (change of SCr from baseline (SCr/Base)or fluid overload) and patient risk factors (ICU admission, stem cell transplantation, ventilation and inotropes). In this study the primary objective to investigate the predictive ability of RAI and cystatin C on day 0 for the development of severe AKI (stages 2 and 3 KDIGO classification at day 3) and secondary outcomes for prediction of need of RRT, need of mechanical ventilation, vasoactive drug use and mortality. In addition, diagnostic accuracy of a combination of RAI and serum cystatin C in predicting severe AKI was also analysed. Summary 131 To achieve this target, this study enrolled 93 critically ill patients, one month to 18 years old, admitted to the PICU at Menoufia University Hospital between May 2020 and May 2021. Patients with chronic or any kidney disease, Patients who receive renal replacement therapy, Patients discharged from PICU before 3 days were excluded from the study. On third day of admission, Enrolled patients were sub grouped according to the presence of AKI according to KIDGO guidelines to patients with AKI group (n=66) and no AKI group (n=27). All children incorporated in the study were subjected to: careful history taking, thorough clinical examination and laboratory investigations, serum cystatin C was done, pSOFA score was calculated within 24hrs of admission for each patient, PRISM III, PIM2 score to detect mortality rate. Clinical outcomes, such as need of vasoactive drug, duration of mechanical ventilation, need for renal replacement therapy and mortality were recorded. RAI score was determined on first day of PICU admission (Day 0 RAI). RAI was calculated from multiply risk score × injury score. Renal angina index ≥8 was considered fulfillment of renal angina. Prediction of Day 3–AKI by the RAI, cystatin C and after incorporation of biomarkers with RAI was analysed. We founded that AKI is common among critically ill children with incidence of (71%).The incidence of sever AKI (stage 2, 3 KIDGO) was 53.7%. In our study, ROC curve analysis showed fair performance of RAI in predicting sever AKI, RRT, need of mechanical ventilation, vasoactive drug use and mortality. Summary 132 We found ROC curve analysis showed fair performance of serum cystatin C in predicting AKI and mortality. There was a significant correlation between serum cystatin C levels with RAI and AKI. The results showed significant correlations between RAI and serum cystatin C, creatinine, AKI and mortality scores. AKI patients had significantly higher serum cystatin C levels than non-AKI patients. Mechanical ventilation use; RRT, vasoactive drug administration and mortality rate were significantly higher in patients with AKI than those with no AKI. Higher proportion of children with positive RAI developed severe AKI, compared to negative RAI group. Multivariate stepwise regression analysis demonstrated that RAI was an independent predictor of AKI. Incorporation of cystatin C with RAI increases AUC, sensitivity and specificity of prediction of AKI. We conclude that risk stratification using renal angina will aid with the prediction of severe AKI and that renal angina prodrome, in conjunction with AKI biomarker measurement, may reliably differentiate patients who will Kidney be responsive to appropriate restorative therapy from those will progress to severe subsequent AKI. |