Abstract: FR-PO056

Subclinical AKI Is Associated with Poor Patient Outcomes in Critically Ill Children

Session Information

  • AKI Clinical: Predictors
    November 03, 2017 | Location: Hall H, Morial Convention Center
    Abstract Time: 10:00 AM - 10:00 AM

Category: Acute Kidney Injury

  • 003 AKI: Clinical and Translational

Authors

  • Stanski, Natalja, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
  • Menon, Shina, Seattle Children's Hospital, University of Washington, Seattle, Washington, United States
  • Goldstein, Stuart, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
  • Basu, Rajit K., Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
Background

The diagnosis of acute kidney injury (AKI) depends on the detection of increases in serum creatinine (SCr), which can result in delayed recognition. Neutrophil gelatinase-associated lipocalin (NGAL) is a biomarker of renal tubular injury that rises early and can be used to detect AKI sooner. Subclinical AKI, a state defined by biomarker positivity in the absence of SCr elevation, has not been well studied in children thus far.

Methods

We conducted a single center, prospective study of children admitted to the ICU with urinary NGAL and SCr samples collected in the first day of admission. NGAL elevation (NGAL+) was defined as >500 ng/ml and SCr elevation (SCr+) was defined as KDIGO stage 1 AKI or greater. Patients were separated into 4 groups: NGAL+/SCr+, NGAL+/SCr-, NGAL-/SCr+ and NGAL-/SCr-. Groups were compared across a variety of outcomes: in-hospital mortality, need for renal replacement therapy (RRT) (primary outcomes), incidence and duration of mechanical ventilation, ICU and hospital length of stay (LOS), organ failure days and incidence of late onset-AKI (day 3-7). Particular attention was paid to the comparison of the NGAL-/SCr- and NGAL+/SCr- groups.

Results

178 patients (51.6% male, median age 6.7 years) were included. 115 (64.6%) were NGAL-/SCr-, 12 (6.7%) were NGAL+/SCr-, 26 (14.6%) were NGAL-/SCr+ and 25 (14.1%) were NGAL+/SCr+. Compared to NGAL-/SCr- patients, NGAL+/SCr- patients had higher odds of in-hospital mortality [OR 1.64 (95% CI: 0.18,14.8) p=0.66], need for mechanical ventilation [OR 2.92 (95% CI: 0.61,13.9) p=0.18], and late-onset AKI [OR 2.5 (95% CI: 0.68,9.1) p=0.16]. This group also had longer mean duration of mechanical ventilation, more organ failure days, and longer LOS (both ICU and hospital). There was no difference in need for RRT initiation as no patients in either group required RRT use.

Conclusion

Elevated urine NGAL on ICU admission is associated with increased morbidity and mortality in pediatric patients, even in the absence of elevated SCr, and may represent a state of subclinical AKI.