ASN's Mission

ASN leads the fight to prevent, treat, and cure kidney diseases throughout the world by educating health professionals and scientists, advancing research and innovation, communicating new knowledge, and advocating for the highest quality care for patients.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005

email@asn-online.org

202-640-4660

The Latest on Twitter

Kidney Week

Abstract: FR-PO049

Subclinical AKI Is Associated with Adverse Outcomes in Critically Ill Neonates and Children

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Author

  • Li, Yanhong, children hospital of Soochow University, Suzhou, China
Background

Acute kidney injury (AKI) is associated with adverse outcomes. Research in AKI has focused on identifying early biomarkers capable of detecting kidney injury before the rise in serum creatinine. However, whether AKI could be diagnosed in the absence of the classic signs of clinical AKI, and whether the condition of subclinical AKI, identified by using structural or functional biomarkers in the absence of oliguria or increased serum creatinine levels, is clinical significant, remained to be elucidated in critically ill children. The aims of the study were to investigate the association of urinary cystatin C (uCysC) level and mortality, and determine whether uCysC-positive subclinical AKI was associated with adverse outcomes in critically ill neonates and children.

Methods

In this prospective cohort study, uCysC levels were serially measured during the first week after intensive care unit (ICU) admission in a heterogeneous group of patients (n=510) presenting to a tertiary neonatal (n=239) and pediatric (n=271) ICU. The term of “uCysC(−)” or “uCysC(+)”, indicating the absence or presence of tubular injury, was defined by the optimal cut-off value of the peak uCysC to predict ICU mortality.

Results

The initial and peak uCysC levels had odds ratios of 1.19 and 1.26 (per 10,000 ng/mg uCr increase), and achieved the area under-the-receiver-operating-characteristic curve of 0.76 and 0.81, respectively, for predicting ICU mortality. At the optimal cut-off value of 1,260 ng/mg uCr, the peak uCysC displayed sensitivity of 79.2% and specificity of 72.3% for predicting mortality. Among all patients, 130 (25.5%) developed uCysC(+)/AKI(−) status during the first week after admission. The adjusted odds ratio for patients with uCysC(+)/AKI(−) status being associated with an increased risk of mortality was 9.34 (P<0.001), compared to those with uCysC(−)/AKI(−). Patients with uCysC(+)/AKI(−) spent 2.8 times as long in ICU compared to those with uCysC(−)/AKI(−).

Conclusion

Both initial and peak uCysC levels are independently predictive of mortality in critically ill neonates and children. Subclinical AKI may occur without detectable loss of kidney function, and uCysC-positive subclinical AKI was associated with worse clinical outcomes in this population.