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• W3154336476 abstract "The initial diagnosis and staging of AKI by KDIGO creatinine criteria is based on small increase of serum creatinine (sCr) from baseline.To estimate if a change in sCr represents a true change in child, the intrinsic or intra-individual biological variation (CVi) of sCr must be taken into account.Objective :To estimate the reference change value (CVi) of serum creatinine in Indian children. To compare the burden and severity of AKI in critically ill children according to “paediatric reference change value optimized for AKI in children” (pROCK) and KDIGO creatinine criteria (0.3 mg/dL or 50% increase from baseline), and their association with morbidity and risk of in-hospital mortality A total of 199 paired results for sCr measured within 30 days, obtained from children aged 1-10 years without any risk factors for AKI were analyzed and used to derive the 95th percentile reference change value (RCV) based on the age and initial creatinine. AKI according to pROCK was defined as increase in sCr after adjusting for RCV. pROCK was applied in a cohort of 175 critically ill children (age <10 years) recruited from an ongoing observational study in pediatric intensive care unit from august 2019 to april 2020. We compared the burden of AKI in 175 hospitalized children according to pROCK and KDIGO creatinine criteria, and their association with risk of in-hospital morbidity and mortality. The median age of the cohort was 2.8 years (0.3 to 10 years).The most common diagnosis was sepsis with septic shock(60%).The mean prism III score was15 ( range 8 to 26) and cumulative fluid overload was 11.5% ( 6.6 to 31.5%). The need for ventilation was in 65% with invasive ventilation in 50%.The need for inotropic support was 46% with average vasoactive inotropic score of 66.7(20 to 250).The overall burden of AKI by KDIGO staging was 40% (n=69) with requirement of renal replacement therapy (RRT) in 20.4% (average duration of RRT was 140 hours).The most common indication for RRT was oligoanuria (88%) followed by refractory metabolic acidosis (82%).The cohort was further analysed for reclassification of AKI staging by using p ROCK. The overall burden of AKI reduced by 17 % (n =39) (39.4% in KDIGO group versus 22.2% in the p ROCK).Stages I, II and III by KDIGO changed from 42%, 33.3% and 24.6% to 32% ,7.2% and 17.3% when reclassified using the p ROCK. Majority (83 %) with stage I and 26% with stage II AKI by KDIGO staging were reclassified as not having AKI using pROCK while 74% with stage II AKI were reclassified as stage I AKI (Table 1). There was no difference in patient outcome between KDIGO based and pROCK based staging of AKI with duration of ventilation, inotropes, ICU and hospital stay being significantly higher in those with AKI compared to those without AKI in both groups. Children with AKI by KDIGO (OR= 4.32; 95% CI 1.88 -9.94) as well as p ROCK group (OR=3.32; 95 CI 1.46-7.7) had higher mortality compared to those without AKI. Table 1Change in staging of AKI by p ROCK compared to KDIGO criteriapROCK KDIGONO AKIStage IStage IIStage IIINo AKI136000Stage I24500Stage II61700Stage III00512 Open table in a new tab In critically ill children, the diagnosis and severity of AKI based on RCV adjusted serum creatinine is lower when compared to KDIGO criteria. However, there was no impact on morbidity or mortality." @default.
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• W3154336476 date "2021-04-01" @default.
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• W3154336476 title "POS-051 IMPACT OF USING REFERENCE CHANGE VALUE OF SERUM CREATININE IN THE DIAGNOSIS, STAGING AND OUTCOME OF ACUTE KIDNEY INJURY IN CRITICALLY ILL CHILDREN:AN INTERIM ANALYSIS" @default.
• W3154336476 doi "https://doi.org/10.1016/j.ekir.2021.03.057" @default.
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