Abstract
Aim/Objectives: To study the incidence, clinical-profile of AKI developing in critically-ill children after admission to PICU, including its risk-factors and determinants affecting patient outcome. Material/Methods: This prospective observational study was conducted at a tertiary teaching hospital (Pt JNM Medical College Raipur, CG, India) over a study period of 12 months (August 2017-July 2018). Those patients who satisfied the inclusion-criteria of having critical-illness requiring PICU admission, age between 1month to 18 years,anddevelopingin-hospital AKI were enrolled; and after obtaining written informed-consent from parents, their basic demographic, clinical details and laboratory reports were entered from case records into predesigned proforma and then data was compiled in Microsoft Excel-Sheet. AKI staging was obtained using pRIFLE criteria (2007) and compared with renal-recovery and patient-survival. SPSS software (version 21) was used for data-analysis and p-value <0.05 was taken for statistical significance. Results: Out of total 1042 critically-ill children admitted during study-period, 103 developed new-onset AKI in PICU (overall incidence 9.8%). Among them, 96 patients died (93.2%cases). Maximum subjects developing in-hospital AKI had three major associated fatal risk-factors like refractory shock (80.5%), severe sepsis (68%) and MODS (62.1%). But only MODS (p=0.002) and refractory-shock (p=0.0001) showed significant association with fatal outcome. Maximum new-onset AKI cases developed within 3 days of PICU admission (62%). No statistically-significant association was observed between different AKI-stages and renal-recovery or patient-survival. Conclusion: Sepsis was common underlying risk-factor for new-onset AKI in critically-ill patients admitted in PICU, while association of MODS and/or refractory shock majorly determined poor survival-outcome.
Highlights
Acute kidney injury (AKI) or acute renal failure (ARF), is usually defined as an abrupt decline in renal function, presenting clinically as a reversible acute increase in nitrogenous wastes over the course of few hours to weeks
Incidence of new- onset AKI in the study setting: In this hospital based observational study conducted over one-year period, total 1570 patients were admitted in Pediatric intensive care unit (PICU)
We grouped total 1042 PICU patients into 4 major age-groups: 1 month - 1 year (43.9%), 1 - 6 years (13.7%), 6-12 years (27%), and 12-18 years (15.4%), since clinico-etiological profile or risk-factors of AKI and underlying-disease pattern vary in different age groups
Summary
Acute kidney injury (AKI) or acute renal failure (ARF), is usually defined as an abrupt decline in renal function, presenting clinically as a reversible acute increase in nitrogenous wastes (blood urea nitrogen and serum creatinine levels) over the course of few hours to weeks. There is trend of significantly higher incidence of AKI amongst critically ill patients of ICUs compared to all patients admitted to any hospital. In the critically ill patients (both in adults and children), sepsis is the major cause or risk-factor for AKI, accounting for nearly 50% of cases. Mortality rates in critically ill paediatric patients developing AKI are usually high, ranging between 9% and 67%. Acute renal insult’ is currently defined/categorized based on severity of renal compromise based on RIFLE
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