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Prognostic relevance of early AKI according to pRIFLE criteria in children undergoing cardiac surgery

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Abstract

Background

Acute renal injury increases risk of death after cardiac surgery. The objective of the study was to evaluate the ability of the pediatric Risk, Injury, Failure, Loss, End-Stage Renal Disease (pRIFLE) criteria to characterize the development of postoperative renal damage in children after cardiopulmonary bypass (CPB) and to evaluate the relationship between the severity of kidney injury and mortality, pediatric intensive care unit (PICU) length of stay, and the duration of mechanical ventilation (MV).

Methods

In this retrospective study including children undergoing CPB surgery during a 3-year period in the PICU of a tertiary hospital, demographic, clinical, surgery-related, and postoperative clinical data were collected. Kidney damage was assessed with pRIFLE criteria.

Results

Four hundred and nine patients were included. Early acute kidney injury (AKI) was found in 82 patients (achieving categories Risk 44; Injury 16; Failure 22). Early AKI was associated with younger age (P = 0.010), longer CPB, deep hypothermic circulatory arrest (DHCA) use, ICU stay >12 days, MV >4 days, and death (P < 0.001). Controlling the effect of age, CPB, DHCA use, previous cardiac surgeries, and Risk Adjustment in Congenital Heart Surgery Surgical Severity Score (RACHS-1), early AKI development proved to predict ICU stay >12 days [odds ratio (OR) 3.5; 95 % confidence interval (CI) 1.9–6.5, P < 0.001)] and need of MV >4 days (OR 5.1; 95 % CI 2.6–10.2, P < 0.001).

Conclusions

Early AKI when evaluated with the pRIFLE criteria can predict prolonged ICU stay, need of prolonged MV, and mortality.

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Acknowledgments

The authors gratefully acknowledge the assistance of the medical and nursing staff of the PICU and the laboratory technicians of the Gregorio Marañón General University Hospital. We also thank Dr. J.M. Bellón for his help in statistical analysis.

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Division of Pediatric Critical Care, Gregorio Marañón General University Hospital, Calle Paseo de la Habana n°74, Torre Norte 6°A, 28036, Madrid, Spain

    Maite Augusta Gil-Ruiz Gil-Esparza

  2. Division of Pediatric Critical Care, Gregorio Marañón General University Hospital, Calle Dr. Castelo 47, 28009, Madrid, Spain

    Andrés José Alcaraz Romero, Alfonso Romero Otero, Eva Sanavia Morán, Ana Rodríguez Sánchez de la Blanca & Jorge Lorente Romero

  3. Division of Pediatric Cardiology, Gregorio Marañón General University Hospital, Madrid, Spain

    Nuria Gil Villanueva

  4. Department of Support Statistical Analysis, Gregorio Marañón General University Hospital, Madrid, Spain

    José María Bellón Cano

Authors
  1. Maite Augusta Gil-Ruiz Gil-Esparza
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  2. Andrés José Alcaraz Romero
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  3. Alfonso Romero Otero
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  4. Nuria Gil Villanueva
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  5. Eva Sanavia Morán
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  6. Ana Rodríguez Sánchez de la Blanca
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  7. Jorge Lorente Romero
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  8. José María Bellón Cano
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Correspondence to Maite Augusta Gil-Ruiz Gil-Esparza.

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Gil-Ruiz Gil-Esparza, M.A., Alcaraz Romero, A.J., Romero Otero, A. et al. Prognostic relevance of early AKI according to pRIFLE criteria in children undergoing cardiac surgery. Pediatr Nephrol 29, 1265–1272 (2014). https://doi.org/10.1007/s00467-014-2757-z

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  • DOI: https://doi.org/10.1007/s00467-014-2757-z

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