Identifying critically ill children at high risk of acute kidney injury and renal replacement therapy

• DOI: 10.1371/journal.pone.0240360
• Publication Date: 2020-10-29T17:50:11Z
• Authors: Rachel J. McGalliard; Stephen J. McWilliam; Samuel Maguire; Caroline A. Jones; Rebecca J. Jennings; Sarah Siner; Paul Newland; Matthew Peak; Christine Chesters; Graham Jeffers; Caroline Broughton; Lynsey McColl; Steven Lane; Stephane Paulus; Nigel A. Cunliffe; Paul Baines; Enitan D. Carrol
• Keywords: Renal replacement therapy; SOFA score

Acute kidney injury (AKI), a common complication in paediatric intensive care units (PICU), is associated with increased morbidity and mortality. In this single centre, prospective, observational cohort study, neutrophil gelatinase-associated lipocalin urine (uNGAL) plasma (pNGAL) renal angina index (RAI), combinations of these markers, were assessed for their ability to predict severe (stage 2 or 3) AKI children young people admitted PICU. PICU had initial serial uNGAL pNGAL measurements, RAI calculation on day 1, collection clinical data, including serum creatinine measurements. Primary outcomes replacement therapy (RRT). Secondary length stay, hospital acquired infection The area under the Receiver Operating Characteristic (ROC) curves Youden was used determine biomarker performance identify optimum cut-off values. Of 657 recruited, 104 met criteria (15∙8%) 47 (7∙2%) required RRT. Severe infection, curve (AUC) prediction Day 1 uNGAL, 0.75 (95% Confidence Interval [CI] 0∙69, 0∙81), 0∙64 CI 0∙56, 0∙72), 0.73 0∙65, 0∙80) respectively. optimal combination measures giving an AUC 0∙80 0∙71, 0∙88). heterogenous cohort, NGAL isolation poorer accuracy than previously reported homogeneous populations. However, when combined together RAI, they produced good AKI.