Academic Journal
Identifying critically ill children at high risk of acute kidney injury and renal replacement therapy.
| Title: | Identifying critically ill children at high risk of acute kidney injury and renal replacement therapy. |
|---|---|
| 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 |
| Source: | PLoS ONE, Vol 15, Iss 10, p e0240360 (2020) |
| Publisher Information: | Public Library of Science (PLoS), 2020. |
| Publication Year: | 2020 |
| Collection: | LCC:Medicine LCC:Science |
| Subject Terms: | Medicine, Science |
| More Details: | 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 in urine (uNGAL) and plasma (pNGAL) and renal angina index (RAI), and combinations of these markers, were assessed for their ability to predict severe (stage 2 or 3) AKI in children and young people admitted to PICU. In PICU children and young people had initial and serial uNGAL and pNGAL measurements, RAI calculation on day 1, and collection of clinical data, including serum creatinine measurements. Primary outcomes were severe AKI and renal replacement therapy (RRT). Secondary outcomes were length of stay, hospital acquired infection and mortality. The area under the Receiver Operating Characteristic (ROC) curves and Youden index was used to determine biomarker performance and identify optimum cut-off values. Of 657 children recruited, 104 met criteria for severe AKI (15∙8%) and 47 (7∙2%) required RRT. Severe AKI was associated with increased length of stay, hospital acquired infection, and mortality. The area under the curve (AUC) for severe AKI prediction for Day 1 uNGAL, Day 1 pNGAL and RAI were 0.75 (95% Confidence Interval [CI] 0∙69, 0∙81), 0∙64 (95% CI 0∙56, 0∙72), and 0.73 (95% CI 0∙65, 0∙80) respectively. The optimal combination of measures was RAI and day 1 uNGAL, giving an AUC of 0∙80 for severe AKI prediction (95% CI 0∙71, 0∙88). In this heterogenous PICU cohort, urine or plasma NGAL in isolation had poorer prediction accuracy for severe AKI than in previously reported homogeneous populations. However, when combined together with RAI, they produced good prediction for severe AKI. |
| Document Type: | article |
| File Description: | electronic resource |
| Language: | English |
| ISSN: | 1932-6203 |
| Relation: | https://doaj.org/toc/1932-6203 |
| DOI: | 10.1371/journal.pone.0240360 |
| Access URL: | https://doaj.org/article/0b8520adcbc9470b95aad7e286d45cfb |
| Accession Number: | edsdoj.0b8520adcbc9470b95aad7e286d45cfb |
| Database: | Directory of Open Access Journals |
| Full text is not displayed to guests. | Login for full access. |
| ISSN: | 19326203 |
|---|---|
| DOI: | 10.1371/journal.pone.0240360 |
| Published in: | PLoS ONE |
| Language: | English |