Incidence, risk factors, clinical profile, and determinants (affecting outcome) of new onset acute kidney injury developing in critically Illpatients in pediatric intensive care unit of a tertiary hospital in middle India

Abstract

Aim/Objectives: To study the incidence, clinical-profile of AKI developing in critically-ill children after admission to PICU, including its risk-factors and determinants affecting patient outcome.

Material/Methods: This prospective observational study was conducted at a tertiary teaching hospital (Pt JNM Medical College Raipur, CG, India) over a study period of 12 months (August 2017-July 2018). Those patients who satisfied the inclusion-criteria of having critical-illness requiring PICU admission, age between 1month to 18 years,anddevelopingin-hospital AKI were enrolled; and after obtaining written informed-consent from parents, their basic demographic, clinical details and laboratory reports were entered from case records into predesigned proforma and then data was compiled in Microsoft Excel-Sheet. AKI staging was obtained using pRIFLE criteria (2007) and compared with renal-recovery and patient-survival. SPSS software (version 21) was used for data-analysis and p-value <0.05 was taken for statistical significance.

Results: Out of total 1042 critically-ill children admitted during study-period, 103 developed new-onset AKI in PICU (overall incidence 9.8%). Among them, 96 patients died (93.2%cases). Maximum subjects developing in-hospital AKI had three major associated fatal risk-factors like refractory shock (80.5%), severe sepsis (68%) and MODS (62.1%). But only MODS (p=0.002) and refractory-shock (p=0.0001) showed significant association with fatal outcome. Maximum new-onset AKI cases developed within 3 days of PICU admission (62%). No statistically-significant association was observed between different AKI-stages and renal-recovery or patient-survival.

Conclusion: Sepsis was common underlying risk-factor for new-onset AKI in critically-ill patients admitted in PICU, while association of MODS and/or refractory shock majorly determined poor survival-outcome.