Validation of the KDIGO acute kidney injury criteria in a pediatric critical care population
Purpose Acute kidney injury (AKI) occurs commonly in critically ill children and has been associated with increased mortality of up to 50 %. The Kidney Disease: Improving Global Outcomes (KDIGO) AKI working group has proposed a standardized definition of AKI. Utilizing routinely available clinical d...
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| Veröffentlicht in: | Intensive care medicine Jg. 40; H. 10; S. 1481 - 1488 |
|---|---|
| Hauptverfasser: | , , , , , , , , , , , , |
| Format: | Journal Article |
| Sprache: | Englisch |
| Veröffentlicht: |
Berlin/Heidelberg
Springer Berlin Heidelberg
01.10.2014
Springer Springer Nature B.V |
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| ISSN: | 0342-4642, 1432-1238, 1432-1238 |
| Online-Zugang: | Volltext |
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| Abstract | Purpose
Acute kidney injury (AKI) occurs commonly in critically ill children and has been associated with increased mortality of up to 50 %. The Kidney Disease: Improving Global Outcomes (KDIGO) AKI working group has proposed a standardized definition of AKI. Utilizing routinely available clinical data, we evaluated the KDIGO AKI criteria and the relationship of AKI with relevant outcomes in a single center tertiary pediatric intensive care (PICU) and cardiac intensive care unit (CICU) population.
Methods
The University of Michigan Pediatric Critical Care Database was probed for all discharges from the pediatric intensive care and cardiac intensive care units between July 2011 and October 2013 (
N
= 4,645). The KDIGO serum creatinine (SCr)-based criteria staged AKI with the modification that a minimum SCr of greater than 0.5 mg/dL was required to be classified as AKI. Exclusion: end-stage renal disease, new renal transplant, missing PRISM III data, or no measured Cr during intensive care unit (ICU) admission (
N
= 1,636).
Results
AKI occurred in 737 (24.5 %, stage 1 = 193, stage 2 = 189, and stage 3 = 355) of 3,009 discharges (PICU
N
= 1,870, CICU
N
= 1,139) that included 2,415 patients. In multivariate analysis AKI was associated with increased ICU length of stay (LOS) in hours (stage I
β
= 42.2,
p
= 0.024, II
β
= 74.1,
p
= 0.003, III
β
= 215.8,
p
< 0.001). Multivariate analysis showed that AKI was associated with increased odds of ICU mortality (OR 3.4, 95 % CI 2.0–6.0) and increased length of mechanical ventilation among those requiring mechanical ventilation (
β
= 2.3 days,
p
< 0.001).
Conclusions
Using the KDIGO criteria to define AKI, we observed a high prevalence of AKI among critically ill children. Worsening stages of AKI were associated with increased ICU LOS, and AKI was independently associated with prolonged mechanical ventilation and increased mortality. The KDIGO criteria describe clinically relevant AKI in a broad pediatric critical care population. |
|---|---|
| AbstractList | Acute kidney injury (AKI) occurs commonly in critically ill children and has been associated with increased mortality of up to 50 %. The Kidney Disease: Improving Global Outcomes (KDIGO) AKI working group has proposed a standardized definition of AKI. Utilizing routinely available clinical data, we evaluated the KDIGO AKI criteria and the relationship of AKI with relevant outcomes in a single center tertiary pediatric intensive care (PICU) and cardiac intensive care unit (CICU) population.
The University of Michigan Pediatric Critical Care Database was probed for all discharges from the pediatric intensive care and cardiac intensive care units between July 2011 and October 2013 (N = 4,645). The KDIGO serum creatinine (SCr)-based criteria staged AKI with the modification that a minimum SCr of greater than 0.5 mg/dL was required to be classified as AKI. Exclusion: end-stage renal disease, new renal transplant, missing PRISM III data, or no measured Cr during intensive care unit (ICU) admission (N = 1,636).
AKI occurred in 737 (24.5 %, stage 1 = 193, stage 2 = 189, and stage 3 = 355) of 3,009 discharges (PICU N = 1,870, CICU N = 1,139) that included 2,415 patients. In multivariate analysis AKI was associated with increased ICU length of stay (LOS) in hours (stage I β = 42.2, p = 0.024, II β = 74.1, p = 0.003, III β = 215.8, p < 0.001). Multivariate analysis showed that AKI was associated with increased odds of ICU mortality (OR 3.4, 95 % CI 2.0-6.0) and increased length of mechanical ventilation among those requiring mechanical ventilation (β = 2.3 days, p < 0.001).
Using the KDIGO criteria to define AKI, we observed a high prevalence of AKI among critically ill children. Worsening stages of AKI were associated with increased ICU LOS, and AKI was independently associated with prolonged mechanical ventilation and increased mortality. The KDIGO criteria describe clinically relevant AKI in a broad pediatric critical care population. Acute kidney injury (AKI) occurs commonly in critically ill children and has been associated with increased mortality of up to 50 %. The Kidney Disease: Improving Global Outcomes (KDIGO) AKI working group has proposed a standardized definition of AKI. Utilizing routinely available clinical data, we evaluated the KDIGO AKI criteria and the relationship of AKI with relevant outcomes in a single center tertiary pediatric intensive care (PICU) and cardiac intensive care unit (CICU) population. The University of Michigan Pediatric Critical Care Database was probed for all discharges from the pediatric intensive care and cardiac intensive care units between July 2011 and October 2013 (N = 4,645). The KDIGO serum creatinine (SCr)-based criteria staged AKI with the modification that a minimum SCr of greater than 0.5 mg/dL was required to be classified as AKI. Exclusion: end-stage renal disease, new renal transplant, missing PRISM III data, or no measured Cr during intensive care unit (ICU) admission (N = 1,636). AKI occurred in 737 (24.5 %, stage 1 = 193, stage 2 = 189, and stage 3 = 355) of 3,009 discharges (PICU N = 1,870, CICU N = 1,139) that included 2,415 patients. In multivariate analysis AKI was associated with increased ICU length of stay (LOS) in hours (stage I [beta] = 42.2, p = 0.024, II [beta] = 74.1, p = 0.003, III [beta] = 215.8, p < 0.001). Multivariate analysis showed that AKI was associated with increased odds of ICU mortality (OR 3.4, 95 % CI 2.0-6.0) and increased length of mechanical ventilation among those requiring mechanical ventilation ([beta] = 2.3 days, p < 0.001). Using the KDIGO criteria to define AKI, we observed a high prevalence of AKI among critically ill children. Worsening stages of AKI were associated with increased ICU LOS, and AKI was independently associated with prolonged mechanical ventilation and increased mortality. The KDIGO criteria describe clinically relevant AKI in a broad pediatric critical care population. Purpose Acute kidney injury (AKI) occurs commonly in critically ill children and has been associated with increased mortality of up to 50 %. The Kidney Disease: Improving Global Outcomes (KDIGO) AKI working group has proposed a standardized definition of AKI. Utilizing routinely available clinical data, we evaluated the KDIGO AKI criteria and the relationship of AKI with relevant outcomes in a single center tertiary pediatric intensive care (PICU) and cardiac intensive care unit (CICU) population. Methods The University of Michigan Pediatric Critical Care Database was probed for all discharges from the pediatric intensive care and cardiac intensive care units between July 2011 and October 2013 ( N = 4,645). The KDIGO serum creatinine (SCr)-based criteria staged AKI with the modification that a minimum SCr of greater than 0.5 mg/dL was required to be classified as AKI. Exclusion: end-stage renal disease, new renal transplant, missing PRISM III data, or no measured Cr during intensive care unit (ICU) admission ( N = 1,636). Results AKI occurred in 737 (24.5 %, stage 1 = 193, stage 2 = 189, and stage 3 = 355) of 3,009 discharges (PICU N = 1,870, CICU N = 1,139) that included 2,415 patients. In multivariate analysis AKI was associated with increased ICU length of stay (LOS) in hours (stage I β = 42.2, p = 0.024, II β = 74.1, p = 0.003, III β = 215.8, p < 0.001). Multivariate analysis showed that AKI was associated with increased odds of ICU mortality (OR 3.4, 95 % CI 2.0–6.0) and increased length of mechanical ventilation among those requiring mechanical ventilation ( β = 2.3 days, p < 0.001). Conclusions Using the KDIGO criteria to define AKI, we observed a high prevalence of AKI among critically ill children. Worsening stages of AKI were associated with increased ICU LOS, and AKI was independently associated with prolonged mechanical ventilation and increased mortality. The KDIGO criteria describe clinically relevant AKI in a broad pediatric critical care population. Acute kidney injury (AKI) occurs commonly in critically ill children and has been associated with increased mortality of up to 50 %. The Kidney Disease: Improving Global Outcomes (KDIGO) AKI working group has proposed a standardized definition of AKI. Utilizing routinely available clinical data, we evaluated the KDIGO AKI criteria and the relationship of AKI with relevant outcomes in a single center tertiary pediatric intensive care (PICU) and cardiac intensive care unit (CICU) population. The University of Michigan Pediatric Critical Care Database was probed for all discharges from the pediatric intensive care and cardiac intensive care units between July 2011 and October 2013 (N = 4,645). The KDIGO serum creatinine (SCr)-based criteria staged AKI with the modification that a minimum SCr of greater than 0.5 mg/dL was required to be classified as AKI. Exclusion: end-stage renal disease, new renal transplant, missing PRISM III data, or no measured Cr during intensive care unit (ICU) admission (N = 1,636). AKI occurred in 737 (24.5 %, stage 1 = 193, stage 2 = 189, and stage 3 = 355) of 3,009 discharges (PICU N = 1,870, CICU N = 1,139) that included 2,415 patients. In multivariate analysis AKI was associated with increased ICU length of stay (LOS) in hours (stage I [beta] = 42.2, p = 0.024, II [beta] = 74.1, p = 0.003, III [beta] = 215.8, p < 0.001). Multivariate analysis showed that AKI was associated with increased odds of ICU mortality (OR 3.4, 95 % CI 2.0-6.0) and increased length of mechanical ventilation among those requiring mechanical ventilation ([beta] = 2.3 days, p < 0.001). Using the KDIGO criteria to define AKI, we observed a high prevalence of AKI among critically ill children. Worsening stages of AKI were associated with increased ICU LOS, and AKI was independently associated with prolonged mechanical ventilation and increased mortality. The KDIGO criteria describe clinically relevant AKI in a broad pediatric critical care population.[PUBLICATION ABSTRACT] Acute kidney injury (AKI) occurs commonly in critically ill children and has been associated with increased mortality of up to 50 %. The Kidney Disease: Improving Global Outcomes (KDIGO) AKI working group has proposed a standardized definition of AKI. Utilizing routinely available clinical data, we evaluated the KDIGO AKI criteria and the relationship of AKI with relevant outcomes in a single center tertiary pediatric intensive care (PICU) and cardiac intensive care unit (CICU) population.PURPOSEAcute kidney injury (AKI) occurs commonly in critically ill children and has been associated with increased mortality of up to 50 %. The Kidney Disease: Improving Global Outcomes (KDIGO) AKI working group has proposed a standardized definition of AKI. Utilizing routinely available clinical data, we evaluated the KDIGO AKI criteria and the relationship of AKI with relevant outcomes in a single center tertiary pediatric intensive care (PICU) and cardiac intensive care unit (CICU) population.The University of Michigan Pediatric Critical Care Database was probed for all discharges from the pediatric intensive care and cardiac intensive care units between July 2011 and October 2013 (N = 4,645). The KDIGO serum creatinine (SCr)-based criteria staged AKI with the modification that a minimum SCr of greater than 0.5 mg/dL was required to be classified as AKI. Exclusion: end-stage renal disease, new renal transplant, missing PRISM III data, or no measured Cr during intensive care unit (ICU) admission (N = 1,636).METHODSThe University of Michigan Pediatric Critical Care Database was probed for all discharges from the pediatric intensive care and cardiac intensive care units between July 2011 and October 2013 (N = 4,645). The KDIGO serum creatinine (SCr)-based criteria staged AKI with the modification that a minimum SCr of greater than 0.5 mg/dL was required to be classified as AKI. Exclusion: end-stage renal disease, new renal transplant, missing PRISM III data, or no measured Cr during intensive care unit (ICU) admission (N = 1,636).AKI occurred in 737 (24.5 %, stage 1 = 193, stage 2 = 189, and stage 3 = 355) of 3,009 discharges (PICU N = 1,870, CICU N = 1,139) that included 2,415 patients. In multivariate analysis AKI was associated with increased ICU length of stay (LOS) in hours (stage I β = 42.2, p = 0.024, II β = 74.1, p = 0.003, III β = 215.8, p < 0.001). Multivariate analysis showed that AKI was associated with increased odds of ICU mortality (OR 3.4, 95 % CI 2.0-6.0) and increased length of mechanical ventilation among those requiring mechanical ventilation (β = 2.3 days, p < 0.001).RESULTSAKI occurred in 737 (24.5 %, stage 1 = 193, stage 2 = 189, and stage 3 = 355) of 3,009 discharges (PICU N = 1,870, CICU N = 1,139) that included 2,415 patients. In multivariate analysis AKI was associated with increased ICU length of stay (LOS) in hours (stage I β = 42.2, p = 0.024, II β = 74.1, p = 0.003, III β = 215.8, p < 0.001). Multivariate analysis showed that AKI was associated with increased odds of ICU mortality (OR 3.4, 95 % CI 2.0-6.0) and increased length of mechanical ventilation among those requiring mechanical ventilation (β = 2.3 days, p < 0.001).Using the KDIGO criteria to define AKI, we observed a high prevalence of AKI among critically ill children. Worsening stages of AKI were associated with increased ICU LOS, and AKI was independently associated with prolonged mechanical ventilation and increased mortality. The KDIGO criteria describe clinically relevant AKI in a broad pediatric critical care population.CONCLUSIONSUsing the KDIGO criteria to define AKI, we observed a high prevalence of AKI among critically ill children. Worsening stages of AKI were associated with increased ICU LOS, and AKI was independently associated with prolonged mechanical ventilation and increased mortality. The KDIGO criteria describe clinically relevant AKI in a broad pediatric critical care population. Purpose Acute kidney injury (AKI) occurs commonly in critically ill children and has been associated with increased mortality of up to 50 %. The Kidney Disease: Improving Global Outcomes (KDIGO) AKI working group has proposed a standardized definition of AKI. Utilizing routinely available clinical data, we evaluated the KDIGO AKI criteria and the relationship of AKI with relevant outcomes in a single center tertiary pediatric intensive care (PICU) and cardiac intensive care unit (CICU) population. Methods The University of Michigan Pediatric Critical Care Database was probed for all discharges from the pediatric intensive care and cardiac intensive care units between July 2011 and October 2013 (N = 4,645). The KDIGO serum creatinine (SCr)-based criteria staged AKI with the modification that a minimum SCr of greater than 0.5 mg/dL was required to be classified as AKI. Exclusion: end-stage renal disease, new renal transplant, missing PRISM III data, or no measured Cr during intensive care unit (ICU) admission (N = 1,636). Results AKI occurred in 737 (24.5 %, stage 1 = 193, stage 2 = 189, and stage 3 = 355) of 3,009 discharges (PICU N = 1,870, CICU N = 1,139) that included 2,415 patients. In multivariate analysis AKI was associated with increased ICU length of stay (LOS) in hours (stage I [beta] = 42.2, p = 0.024, II [beta] = 74.1, p = 0.003, III [beta] = 215.8, p < 0.001). Multivariate analysis showed that AKI was associated with increased odds of ICU mortality (OR 3.4, 95 % CI 2.0-6.0) and increased length of mechanical ventilation among those requiring mechanical ventilation ([beta] = 2.3 days, p < 0.001). Conclusions Using the KDIGO criteria to define AKI, we observed a high prevalence of AKI among critically ill children. Worsening stages of AKI were associated with increased ICU LOS, and AKI was independently associated with prolonged mechanical ventilation and increased mortality. The KDIGO criteria describe clinically relevant AKI in a broad pediatric critical care population. |
| Audience | Academic |
| Author | Troost, Jonathan P. Blatt, Neal B. Kershaw, David B. Selewski, David T. Ehrmann, Brett J. Gajarski, Robert Shanley, Thomas P. Gipson, Debbie S. Cornell, Timothy T. Luckritz, Kera Heung, Michael Hieber, Sue Lombel, Rebecca M. |
| Author_xml | – sequence: 1 givenname: David T. surname: Selewski fullname: Selewski, David T. email: dselewsk@med.umich.edu organization: Division of Nephrology, Department of Pediatrics and Communicable Diseases, C.S. Mott Children’s Hospital, University of Michigan – sequence: 2 givenname: Timothy T. surname: Cornell fullname: Cornell, Timothy T. organization: Division of Critical Care, Department of Pediatrics and Communicable Diseases, C.S. Mott Children’s Hospital, University of Michigan – sequence: 3 givenname: Michael surname: Heung fullname: Heung, Michael organization: Division of Nephrology, Department of Internal Medicine, University of Michigan – sequence: 4 givenname: Jonathan P. surname: Troost fullname: Troost, Jonathan P. organization: Division of Nephrology, Department of Pediatrics and Communicable Diseases, C.S. Mott Children’s Hospital, University of Michigan – sequence: 5 givenname: Brett J. surname: Ehrmann fullname: Ehrmann, Brett J. organization: Division of Nephrology, Department of Pediatrics and Communicable Diseases, C.S. Mott Children’s Hospital, University of Michigan – sequence: 6 givenname: Rebecca M. surname: Lombel fullname: Lombel, Rebecca M. organization: Division of Nephrology, Department of Pediatrics and Communicable Diseases, C.S. Mott Children’s Hospital, University of Michigan – sequence: 7 givenname: Neal B. surname: Blatt fullname: Blatt, Neal B. organization: Division of Nephrology, Department of Pediatrics and Communicable Diseases, C.S. Mott Children’s Hospital, University of Michigan – sequence: 8 givenname: Kera surname: Luckritz fullname: Luckritz, Kera organization: Division of Nephrology, Department of Pediatrics and Communicable Diseases, C.S. Mott Children’s Hospital, University of Michigan – sequence: 9 givenname: Sue surname: Hieber fullname: Hieber, Sue organization: Division of Nephrology, Department of Pediatrics and Communicable Diseases, C.S. Mott Children’s Hospital, University of Michigan – sequence: 10 givenname: Robert surname: Gajarski fullname: Gajarski, Robert organization: Division of Cardiology, Department of Pediatrics and Communicable Diseases, C.S. Mott Children’s Hospital, University of Michigan – sequence: 11 givenname: David B. surname: Kershaw fullname: Kershaw, David B. organization: Division of Nephrology, Department of Pediatrics and Communicable Diseases, C.S. Mott Children’s Hospital, University of Michigan – sequence: 12 givenname: Thomas P. surname: Shanley fullname: Shanley, Thomas P. organization: Division of Critical Care, Department of Pediatrics and Communicable Diseases, C.S. Mott Children’s Hospital, University of Michigan – sequence: 13 givenname: Debbie S. surname: Gipson fullname: Gipson, Debbie S. organization: Division of Nephrology, Department of Pediatrics and Communicable Diseases, C.S. Mott Children’s Hospital, University of Michigan |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/25079008$$D View this record in MEDLINE/PubMed |
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| Cites_doi | 10.1007/s00134-008-1176-7 10.1097/CCM.0b013e3181cd12e1 10.1097/PCC.0b013e3182745675 10.1186/cc5713 10.1007/s00467-010-1533-y 10.1016/j.pcl.2013.02.006 10.1038/sj.ki.5002231 10.1007/s00467-005-1907-8 10.1007/s00134-009-1530-4 10.1186/cc11808 10.1016/j.jtcvs.2011.06.021 10.1007/s00467-008-1054-0 10.2215/CJN.00270113 10.1038/pr.2013.230 10.1186/cc2872 10.1186/cc10269 10.1186/1741-7015-9-135 10.1097/PCC.0000000000000126 10.1007/s00134-009-1638-6 10.1007/s004670100029 10.1016/j.jpedsurg.2010.11.031 10.1097/00003246-199605000-00004 10.1007/s00134-012-2508-1 |
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report of an initiative to improve outcomes in acute kidney injury publication-title: Crit Care doi: 10.1186/cc5713 – volume: 25 start-page: 2107 year: 2010 end-page: 2113 ident: CR21 article-title: Reference values for serum creatinine in children younger than 1 year of age publication-title: Pediatr Nephrol doi: 10.1007/s00467-010-1533-y – volume: 60 start-page: 669 year: 2013 end-page: 688 ident: CR3 article-title: Acute kidney injury in children: an update on diagnosis and treatment publication-title: Pediatr Clin North Am doi: 10.1016/j.pcl.2013.02.006 – volume: 71 start-page: 1028 year: 2007 end-page: 1035 ident: CR14 article-title: Modified RIFLE criteria in critically ill children with acute kidney injury publication-title: Kidney Int doi: 10.1038/sj.ki.5002231 – volume: 20 start-page: 1473 year: 2005 end-page: 1477 ident: CR6 article-title: Prognosis in critically ill children requiring continuous renal replacement therapy publication-title: Pediatr Nephrol doi: 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Acute kidney injury (AKI) occurs commonly in critically ill children and has been associated with increased mortality of up to 50 %. The Kidney... Acute kidney injury (AKI) occurs commonly in critically ill children and has been associated with increased mortality of up to 50 %. The Kidney Disease:... Purpose Acute kidney injury (AKI) occurs commonly in critically ill children and has been associated with increased mortality of up to 50 %. The Kidney... |
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| SubjectTerms | Acute Kidney Injury - classification Acute Kidney Injury - epidemiology Acute Kidney Injury - mortality Adolescent Analysis Anesthesiology Child Child, Preschool Children Chronic kidney failure Creatinine Creatinine - blood Critical care Critical Care Medicine Critical Illness Emergency Medicine Female Health aspects Hospital Mortality Hospitals Humans Incidence Infant Infant, Newborn Injuries Intensive Intensive care Intensive Care Units, Pediatric Kidney diseases Kidney transplants Length of Stay Linear Models Male Medicine Medicine & Public Health Michigan Mortality Multivariate Analysis Nephrology Original Outcome Assessment (Health Care) Pain Medicine Patient Discharge - statistics & numerical data Patients Pediatric intensive care Pediatrics Pneumology/Respiratory System Respiration, Artificial - statistics & numerical data Retrospective Studies Severity of Illness Index Ventilators |
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| Title | Validation of the KDIGO acute kidney injury criteria in a pediatric critical care population |
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