Abstract: FR-PO070
Standardization of a Furosemide Stress Test in the Pediatric Intensive Care Unit
Session Information
- AKI: Clinical Outcomes, Trials
November 08, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
Authors
- Roy, Jean-Philippe, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
- Krallman, Kelli A., Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
- Chima, Ranjit S., Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
- Schmerge, Alexandra, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
- Gerhardt, Bradley S., Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
- Fei, Lin, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
- Goldstein, Stuart, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
Background
Early prediction of patients (pt) at risk of severe acute kidney injury (sAKI) and need for renal replacement therapy (CRRT) in pediatric intensive care unit (PICU) is a desired strategy for early intervention. Functional assessment of tubular reserve with diuretic, furosemide stress test (FST), has been validated in acutely ill adults with promising prediction for sAKI and CRRT requirement but has not been evaluated in critically ill children.
Methods
Prospective observational study. All PICU admissions have an automated renal angina index (RAI) calculated 12h after admission. RAI positive pt (≥8, RAI+) are assessed with a urine NGAL to improve risk prediction. RAI+/NGAL+ (>150ng/mL, NGAL+) pt are assessed for the FST. The FST include a standard dose of furosemide (1mg/kg if naïve or 1.5mg/kg if exposed within 24h) and hourly urine output (OUP) monitoring 6 hours prior and after the dose administration. Increase in (iOUP) at 2 and 6h were calculated by subtracting the mean hourly UOP per kilogram using the same time length before and after administration. FST was considered positive (FST-responder) if the iOUP met a certain threshold at either one of the time marks.
Results
From 7/1/2018 to 2/28/2019, 1730 pt were admitted, 15 had a FST done, 3 (20%) of which required CRRT. Incremental hourly iOUP cutoff from 1 to 10ml/kg/h show an excellent AUC of 0.847 for CRRT prediction. 5ml/kg/h iOUP had the best Youden’s J index at 0.58 but a 4ml/kg/h cutoff, with second best index, was deemed more clinically relevant due to a better specificity. At this cutoff, 2/4 (50%) FST non-responder vs 1/10 (10%) FST responder required CRRT (p=0.15) (see table).
Conclusion
FST seems applicable in acutely ill children to predict CRRT requirement but with an increase threshold of iUOP. However this prospective cohort will need more FST pt to make any definitive conclusions.
Table - CRRT need prediction with variable iOUP threshold after an FST
| iOUP cutoff (ml/kg/h) | Sensitivity | Specificity | Positive Predictive Value | Negative Predictive Value | Youden |
| 1 | 33% | 100% | 100% | 86% | 0.33 |
| 2 | 33% | 92% | 50% | 85% | 0.25 |
| 3 | 33% | 83% | 33% | 83% | 0.17 |
| 4 | 67% | 83% | 50% | 91% | 0.50 |
| 5 | 100% | 58% | 38% | 100% | 0.58 |
| 6 | 100% | 50% | 33% | 100% | 0.50 |
| 7 | 100% | 50% | 33% | 100% | 0.50 |
Funding
- NIDDK Support