Impact of and risk factors for pediatric acute kidney injury defined by the pROCK criteria in a Chinese PICU population

Abstract

Background

The definition of pediatric AKI continues to evolve. We aimed to find a better AKI definition to predict outcomes and identify risk factors for AKI in a Chinese PICU.

Methods

This study consisted of 3338 patients hospitalized in a Chinese PICU between 2016 and 2018. AKI was defined and staged using pROCK criteria, which were compared with KDIGO criteria. AKI outcomes, including mortality, daily cost and length of stay (LOS), were assessed. Risk factors for AKI were also estimated.

Results

The incidence of AKI in the PICU was 7.7% according to pROCK criteria. The characteristics of patients with KDIGO-defined AKI who did not meet the pROCK were similar to those without AKI. pROCK outperformed KDIGO in predicting mortality with a higher c index in the Cox models (0.81 versus 0.79, P = 0.013). AKI, as well as AKI stages, were associated with higher mortality (HR: 10.5, 95%CI: 6.66–19.5), daily cost (β = 2064, P < 0.01) and LOS (β = 2.30, P < 0.01). Age, comorbidities, mechanical ventilation (MV), pediatric critical illness score (PCIS) and exposure to drugs had significant influence on AKI occurrence.

Conclusions

The mortality predictability of pROCK was slightly greater than that of KDIGO. Older age, underlying comorbidities, MV, decreased PCIS and exposure to drugs were potential risk factors for AKI.

Impact

  • Two AKI criteria, pROCK and KDIGO, were significantly associated with an increased risk of mortality and pROCK was slightly greater than that of KDIGO.

  • Older age, comorbidities, mechanical ventilation, decreased PCIS and exposure to drugs were potential risk factors for AKI.

  • This study first used the pROCK criteria to provide an epidemiologic description of pediatric AKI in Chinese PICU.

  • This study compared the AKI outcomes across the pROCK and KDIGO AKI criteria, indicating the prior utility for AKI classification in Chinese children.

  • This study indicated that the potential risk factors for AKI were older age, comorbidities, mechanical ventilation, decreased PCIS and exposure to drugs.

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Fig. 1: Diagram of cases included in the study and incidence of acute kidney injury (AKI).
Fig. 2: Kaplan–Meier curves of cumulative death hazard by different AKI definitions.

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Acknowledgements

We thank all the participants of the study for their valuable contributions. This work was supported by the Key Research and Development Program Projects in Anhui, China (ID: 1704a0802172).

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C.W., G.H., F.H., and L.H. made substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data; C.W., F.H., L.H., J.D., and Q.X. contributed to the draft of the article or revising it critically for important intellectual content. J.D. contributed to the study on data collection. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Haipeng Liu.

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The authors declare no competing interests.

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Informed consent was waived for the retrospective nature and the lack of participant interaction.

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Cui, W., Gao, H., Fang, H. et al. Impact of and risk factors for pediatric acute kidney injury defined by the pROCK criteria in a Chinese PICU population. Pediatr Res (2020). https://doi.org/10.1038/s41390-020-1059-3

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