• Jingxia Zeng, Hongjun Miao, Zhen Jiang, Yong Zhang, Xiaoli Guo, Qing Chen, Yu Wan, Peng Ji, Guojin Xie, Han Li, Xuejian Mei, Jinsu Zhou, Haisheng Xu, Jie Gu, Jun Cheng, Jianli Chen, Aihua Zhang, and Xuhua Ge.
• Pediatric Intensive Care Unit, Children's Hospital of Nanjing Medical University, Nanjing, China.
• Pediatr Crit Care Me. 2022 Dec 1; 23 (12): e574e582e574-e582.

ObjectivesThe standard definition of pediatric acute kidney injury (AKI) is evolving, especially for critically ill in the PICU. We sought to validate the application of the Pediatric Reference Change Value Optimized for Acute Kidney Injury in Children (pROCK) criteria in critically ill children.DesignMulticenter retrospective study.SettingSix PICUs in mainland China.PatientsOne thousand six hundred seventy-eight hospitalized children admitted to the PICU with at least two creatinine values within 7 days.InterventionsNone.Measurements And Main ResultsAKI was diagnosed and staged according to the Pediatric Risk, Injury, Failure, Loss, End-Stage Renal Disease (pRIFLE), the Kidney Disease Improving Global Outcomes (KDIGO), and the pROCK criteria. Multiple clinical parameters were assessed and analyzed along with 90-day follow-up outcomes. According to the definitions of pRIFLE, KDIGO, and pROCK, the prevalence of AKI in our cohort of 1,678 cases was 52.8% (886), 39.0% (655), and 19.0% (318), respectively. The presence of AKI, as defined by pROCK, was associated with increased number of injured organs, occurrence of sepsis, use of mechanical ventilation, use of continuous renal replace therapy ( p < 0.05), higher Pediatric Risk of Mortality III score, and higher Pediatric Logistic Organ Dysfunction-2 score ( p < 0.001). The survival curve of 90-day outcomes showed that pROCK was associated with shorter survival time (LogRank p < 0.001), and pROCK definition was associated with better separation of the different stages of AKI from non-AKI ( p < 0.001).ConclusionsIn this retrospective analysis of AKI criteria in PICU admissions in China, pROCK is better correlated with severity and outcome of AKI. Hence, the pROCK criteria for AKI may have better utility in critically ill children.Copyright © 2022 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.

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