Predictors of mortality in children with acute kidney injury in intensive care unit

Main Article Content

Umi Rakhmawati
Indah K. Murni
Desy Rusmawatiningtyas

Abstract

Background Acute kidney injury (AKI) can increase the morbidity and mortality in children admitted to the pediatric intensive care unit (PICU). Previous published studies have mostly been conducted in high-income countries. Evaluations of possible predictors of mortality in children with AKI in low- and middle-income countries have been limited, particularly in Indonesia.


Objective To assess possible predictors of mortality in children with AKI in the PICU.


Methods We conducted a retrospective cohort study at Dr. Sardjito Hospital, Yogyakarta, Indonesia. All children with AKI admitted to PICU for more than 24 hours from 2010 to 2016 were eligible and consecutively recruited into the study. Logistic regression analysis was used to identify independent predictors.


Results Of the 152 children with AKI recruited, 119 died. In order to get a P value of <0.25, multivariate analysis is run to degree AKI, ventilator utilization, primary infection disease, MOF and age.Multivariate analysis showed that ventilator use, severe AKI, and infection were independently associated with mortality in children with AKI, with odds ratios (OR) of 19.2 (95%CI 6.2 to 59.7; P<0.001), 8.6 (95%CI 2.7 to 27.6; P<0.001), and 0.2 (95%CI 0.1 to 0.8; P=0.02), respectively.


Conclusion The use of mechanical ventilation and the presence of severe AKI are associated with mortality in children with AKI admitted to the PICU. Interestingly, the presence of infection might be a protective factor from mortality in such patients. 

Article Details

How to Cite
1.
Rakhmawati U, Murni I, Rusmawatiningtyas D. Predictors of mortality in children with acute kidney injury in intensive care unit. PI [Internet]. 11Apr.2019 [cited 26Jun.2019];59(2). Available from: https://paediatricaindonesiana.org/index.php/paediatrica-indonesiana/article/view/2140
Section
Emergency & Pediatric Intensive Care
Received 2019-02-10
Accepted 2019-04-10
Published 2019-04-11

References

1. Nilawati GAP. Kejadian acute kidney injury dengan kriteria pRIFLE pada unit perawatan intensif anak Rumah Sakit Sanglah Denpasar. Sari Pediatri. 2012;14:14–17.
2. Imani PD, Odiit A, Hingorani SR, Weiss NS, Eddy AA. Acute kidney injury and its association with in-hospital mortality among children with acute infections. Pediatr. Nephrol. 2013;28:2199–206.
3. Mehta P, Sinha A, Sami A, Hari P, Kalaivani M, Gulati A, et al. Incidence of acute kidney injury in hospitalized children. Indian Pediatr. 2012;49:537-42.
4. Plotz FB, Bouma AB, van Wijk JAE, Kneyber MCJ, Bokenkamp A. Pediatric acute kidney injury in the ICU: an independent evaluation of pRIFLE criteria. Intensive Care Med. 2008;34:1713-17.
5. Touza Pol P, Galán CR, Villanueva JAM, Martinez-Camblor P, Lopez-Herce J. Severe acute kidney injury in critically ill children: epidemiology and prognostic factors. An Pediatr. 2015;83:367-75.
6. Bresolin N, Bianchini AP, Haas CA. Pediatric acute kidney injury assessed by pRIFLE as a prognostic factor in the intensive care unit. Pediatr Nephrol. 2013;28:485–92.
7. Naik S, Sharma J, Yengkom R, Kalrao V, Mulay A. Acute kidney injury in critically ill children: risk factors and outcomes. Indian J Crit Care Med. 2014;18:129–33.
8. Lemeshow S, Hosmer DW, Klar J, Lwanga SK‎. Adequacy of sample size in health studies. Chichester : Wiley; 1990. [cited 2019 January 28]. Available from: http://www.who.int/iris/handle/10665/41607.
9. Task Force of the American College of Critical Care Medicine, Society of Critical Care Medicine. Guidelines for intensive care unit admission, discharge, and triage. Crit Care Med. 1999;27:633-38.
10. Dahlan MS. Statistik untuk kedokteran dan kesehatan: deskriptif, bivariat, dan multivariat, dilengkapi aplikasi dengan menggunakan SPSS. 6th ed. Jakarta: Epidemiologi Indonesia; 2014. 25-27
11. Nguyen MT, Devarajan P. Biomarkers for the early detection of acute kidney injury. Pediatr Nephrol. 2008;23:2151-7.
12. Rustagi RS, Arora K, Das RR, Pooni PA, Singh D. Incidence, risk factors and outcome of acute kidney injury in critically ill children-a developing country perspective. Paediatr Int Child Health. 2017;37:35-41.
13. Sanchez-Pinto LN, Goldstein SL, Schneider JB, Khemani RG. Association between progression and improvement of acute kidney injury and mortality in critically ill children. Pediatr Crit Care Med. 2015;16:703–10.
14. Al Jboor W, Almardini R, Al Bderat J, Frehat M, Al Masri H, Alajloni MS. Acute kidney injury in critically ill child. Saudi J Kidney Dis Transpl. 2016;27:740-7.
15. Hui WF, Chan WK, Miu TY. Acute kidney injury in the paediatric intensive care unit: identification by modified RIFLE criteria. Hong Kong Med J. 2013;19:13-9.
16. Akcan-Arikan A, Zappitelli M, Loftis LL, Washburn KK, Jefferson LS, Goldstein SL. Modified RIFLE criteria in critically ill children with acute kidney injury. Kidney Int. 2007;71:1028-35.
17. Soler YA, Nieves-Plaza M, Prieto M, Garcia-De Jesus R, Suarez-Rivera M. Pediatric risk, injury, failure, loss, end stage renal disease score identifies acute kidney injury and predicts mortality in critically ill children: a prospective study. Pediatr Crit Care Med. 2013;14:189–95.
18. Cabral FC, Ramos-Garcia PC, Mattiello R, Dresser D, Fiori HH, Korb C, et al. Influence of acute kidney injury defined by the pediatric risk, injury, failure, loss, end-stage renal disease score on the clinical course of PICU patients. Pediatr Crit Care Med. 2015;16:e275-82.
19. Miklaszewska M, Korohoda P, Sobczak A, Horbaczewska A, Filipiak A, Zachwieja K, et al. Acute kidney injury in a single pediatric intensive care unit in Poland: a retrospective study. Kidney Blood Press Res. 2014;39:28–39.
20. Chang JW, Jeng MJ, Yang LY, Chen TJ, Chiang SC, Soong WJ, et al. The epidemiology and prognostic factors of mortality in critically ill children with acute kidney injury in Taiwan. Kidney Inter. 2015;87:632-9.
21. Lameire N, Van Biesen W, Vanholder R. Epidemiology of acute kidney injury in children worldwide, including developing countries. Pediatr Nephrol. 2017;32:1301-4.
22. O'Keefe-McCarthy S, Santiago C, Lau G. Ventilator-associated pneumonia bundled strategies: an evidence-based practice. Worldviews Evid-Based Nurs. 2008;5:193-204.
23. Wright ML, Romano MJ. Ventilator-associated pneumonia in children. Semin Pediatr Infect Dis. 2006;17:58-64.
24. Supariasa. Penilaian Status Gizi. Jakarta: EGC; 2002:50-55.