Acute Kidney Injury in Critically Ill Children: A Retrospective Analysis of Risk Factors.
INTRODUCTION
Children admitted to paediatric intensive care unit (PICU) are at risk of acute kidney injury (AKI). However, few paediatric studies have focused on the identification of factors potentially associated with the development of this condition. The aim of our study was to assess the incidence rate of AKI, identify risk factors, and evaluate clinical outcome in a large sample of critically ill children.


METHODS
This retrospective observational study was conducted including patients admitted to our PICU from January 2014 to December 2016. AKI was defined according to Kidney Disease: Improving Global Outcome criteria.


RESULTS
A total of 222 PICU patients out of 811 (27%) had AKI (stage I 39%, stage II 24%, stage III 37%). The most common PICU admission diagnoses in AKI cases were heart disease (38.6%), respiratory failure (16.8%) and postsurgical non-cardiac patients (11%). Hypoxic-ischaemic was the most frequent cause of AKI. Significant risk factors for AKI following multivariate analysis were age >2 months (OR 2.43; 95% CI 1.03-7.87; p = 0.05), serum creatinine at admission >44 µmol/L (OR 2.23; 95% CI 1.26-3.94; p = 0.006), presence of comorbidities (OR 1.84; 95% CI 1.03-3.30; p = 0.04), use of inotropes (OR 2.56; 95% CI 1.23-5.35; p= 0.012) and diuretics (OR 2.78; 95% CI 1.49-5.19; p = 0.001), exposure to nephrotoxic drugs (OR 1.66; 95% CI 1.01-2.91; p= 0.04), multiple organ dysfunction syndrome (OR 2.68; 95% CI 1.43-5.01; p = 0.002), and coagulopathy (OR 1.89; 95% CI 1.05-3.38, p = 0.03). AKI was associated with a significant longer PICU stay (median LOS of 8 days, interquartile range [IQR] 3-16, versus 4 days, IQR 2-8, in non-AKI patients; p < 0.001). The mortality rate resulted tenfold higher in AKI than non-AKI patients (12.6 vs. 1.2%; p < 0.001).


CONCLUSIONS
The incidence of AKI in critically ill children is high, with an associated increased length of stay and risk of mortality. In the PICU setting, risk factors of AKI are multiple and mainly associated with illness severity.
['De Zan|Francesca|F|', 'Amigoni|Angela|A|', 'Pozzato|Roberta|R|', 'Pettenazzo|Andrea|A|', 'Murer|Luisa|L|', 'Vidal|Enrico|E|']
D058186:Acute Kidney Injury D002648:Child D002675:Child, Preschool D016638:Critical Illness D018572:Disease-Free Survival D005260:Female D017052:Hospital Mortality D006801:Humans D015994:Incidence D007223:Infant D007231:Infant, Newborn D015278:Intensive Care Units, Pediatric D008297:Male D012189:Retrospective Studies D012307:Risk Factors D015996:Survival Rate
Acute kidney injury Critically ill children Outcome Kidney Disease: Improving Global Outcome Pediatric intensive care unit