• Pediatr. Nephrol. · Jul 2014

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

    • Maite Augusta Gil-Ruiz Gil-Esparza, Andrés José Alcaraz Romero, Alfonso Romero Otero, Nuria Gil Villanueva, Eva Sanavia Morán, Ana Rodríguez Sánchez de la Blanca, Jorge Lorente Romero, and José María Bellón Cano.
    • Division of Pediatric Critical Care, Gregorio Marañón General University Hospital, Calle Paseo de la Habana n°74, Torre Norte 6°A, 28036, Madrid, Spain, maitegilr@gmail.com.
    • Pediatr. Nephrol. 2014 Jul 1;29(7):1265-72.

    BackgroundAcute 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).MethodsIn 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.ResultsFour 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).ConclusionsEarly AKI when evaluated with the pRIFLE criteria can predict prolonged ICU stay, need of prolonged MV, and mortality.

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