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Pediatr Nephrol (2014) 29:12651272 DOI 10.1007/s00467-014-2757-z
ORIGINAL ARTICLE
Prognostic relevance of early AKI according to pRIFLE criteria in children undergoing cardiac surgery
Maite Augusta Gil-Ruiz Gil-Esparza & Andrs Jos Alcaraz Romero &
Alfonso Romero Otero & Nuria Gil Villanueva & Eva Sanavia Morn &
Ana Rodrguez Snchez de la Blanca & Jorge Lorente Romero & Jos Mara Belln Cano
Received: 6 June 2013 /Revised: 7 December 2013 /Accepted: 6 January 2014 /Published online: 5 February 2014 # IPNA 2014
AbstractBackground Acute renal injury increases risk of death after cardiac surgery. The objective of the study was to evaluate the ability of the pediatric Risk, Injury, Failure, Loss, End-Stage Renal Disease (pRIFLE) criteria to characterize the development of postoperative renal damage in children after cardio-pulmonary bypass (CPB) and to evaluate the relationship between the severity of kidney injury and mortality, pediatric intensive care unit (PICU) length of stay, and the duration of mechanical ventilation (MV).
Methods In this retrospective study including children undergoing CPB surgery during a 3-year period in the PICU of a tertiary hospital, demographic, clinical, surgery-related, and postoperative clinical data were collected. Kidney damage was assessed with pRIFLE criteria.
Results Four hundred and nine patients were included. Early acute kidney injury (AKI) was found in 82 patients (achieving categories Risk 44; Injury 16; Failure 22). Early AKI was associated with younger age (P=0.010), longer CPB, deep
hypothermic circulatory arrest (DHCA) use, ICU stay >12 days, MV >4 days, and death (P<0.001). Controlling the effect of age, CPB, DHCA use, previous cardiac surgeries, and Risk Adjustment in Congenital Heart Surgery Surgical Severity Score (RACHS-1), early AKI development proved to predict ICU stay >12 days [odds ratio (OR) 3.5; 95 % confidence interval (CI) 1.96.5, P<0.001)] and need of MV >4 days (OR 5.1; 95 % CI 2.610.2, P<0.001). Conclusions Early AKI when evaluated with the pRIFLE criteria can predict prolonged ICU stay, need of prolonged MV, and mortality.
Keywords Acutekidneyinjury .Children .pRIFLE .Cardiac surgery
Introduction
Acute kidney injury (AKI), which varies from a little creatinine increase to an anuric state, is a frequent complication in pediatric intensive care unit (PICU) patients and has been related to a poor outcome of these patients, such as a higher rate of mortality or longer length of stay...