A comparison of the systems for the identification of postoperative acute kidney injury in pediatric cardiac patients

Daniel J. Lex, Roland Tóth, Zsuzsanna Cserép, Stephen I. Alexander, Tamás Breuer, Erzsébet Sápi, A. Szatmári, Edgár Székely, J. Gál, Andrea Székely

Research output: Contribution to journalArticle

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Abstract

Background The pediatric-modified Risk, Injury, Failure and Loss, and End-Stage (pRIFLE) criteria and a different but conceptually similar system termed Acute Kidney Injury Network (AKIN) were created to standardize the definition of acute kidney injury (AKI) in children. Kidney Disease: Improving Global Outcomes (KDIGO) currently recommends a combination of AKIN and pRIFLE in AKI. This study aimed to compare the three classifications for predicting AKI in pediatric patients undergoing cardiac operations. Methods We analyzed the prospectively collected data of 1,489 consecutive pediatric patients undergoing cardiac operations between January 2004 and December 2008. AKI presence and severity was assessed for each classification using the change in serum creatinine and estimated creatinine clearance levels calculated by the Schwartz equation. Results AKI was present in 285 (20%), 481 (34%), and 409 (29%) patients according to the AKIN, pRIFLE, and KDIGO systems, respectively. The KDIGO classification categorized 121 patients (8%) who were placed in the AKIN 0 category, whereas the pRIFLE system categorized 74 (5%) in KDIGO 0 and 200 (14%) in AKIN 0 stages as having an AKI. The overall mortality rate was 3.9%. The KDIGO stage III (odds ratio [OR], 18.8; 95% confidence interval [CI], 9.6 to 36.6, p <0.001), the AKIN stage III (OR, 38.3; 95% CI, 20.6 to 70.9, p <0.001), and pRIFLE failure group (OR, 13.6, 95% CI, 7 to 26.3; p <0.001) were associated with increased mortality. Conclusions The pRIFLE system was the most sensitive test in detecting AKI, and this was especially so in the infant age group and also in the early identification of AKI in low-risk patients. The AKIN system was more specific and detected mostly high-risk patients across all age groups. The KDIGO classification system fell between pRIFLE and AKIN in performance. All three had increasing severity of AKI associated with mortality.

Original languageEnglish
Pages (from-to)202-210
Number of pages9
JournalAnnals of Thoracic Surgery
Volume97
Issue number1
DOIs
Publication statusPublished - Jan 2014

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Acute Kidney Injury
Pediatrics
Kidney Diseases
Wounds and Injuries
Odds Ratio
Confidence Intervals
Mortality
Creatinine
Age Groups
Chronic Kidney Failure

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

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A comparison of the systems for the identification of postoperative acute kidney injury in pediatric cardiac patients. / Lex, Daniel J.; Tóth, Roland; Cserép, Zsuzsanna; Alexander, Stephen I.; Breuer, Tamás; Sápi, Erzsébet; Szatmári, A.; Székely, Edgár; Gál, J.; Székely, Andrea.

In: Annals of Thoracic Surgery, Vol. 97, No. 1, 01.2014, p. 202-210.

Research output: Contribution to journalArticle

Lex, Daniel J. ; Tóth, Roland ; Cserép, Zsuzsanna ; Alexander, Stephen I. ; Breuer, Tamás ; Sápi, Erzsébet ; Szatmári, A. ; Székely, Edgár ; Gál, J. ; Székely, Andrea. / A comparison of the systems for the identification of postoperative acute kidney injury in pediatric cardiac patients. In: Annals of Thoracic Surgery. 2014 ; Vol. 97, No. 1. pp. 202-210.
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abstract = "Background The pediatric-modified Risk, Injury, Failure and Loss, and End-Stage (pRIFLE) criteria and a different but conceptually similar system termed Acute Kidney Injury Network (AKIN) were created to standardize the definition of acute kidney injury (AKI) in children. Kidney Disease: Improving Global Outcomes (KDIGO) currently recommends a combination of AKIN and pRIFLE in AKI. This study aimed to compare the three classifications for predicting AKI in pediatric patients undergoing cardiac operations. Methods We analyzed the prospectively collected data of 1,489 consecutive pediatric patients undergoing cardiac operations between January 2004 and December 2008. AKI presence and severity was assessed for each classification using the change in serum creatinine and estimated creatinine clearance levels calculated by the Schwartz equation. Results AKI was present in 285 (20{\%}), 481 (34{\%}), and 409 (29{\%}) patients according to the AKIN, pRIFLE, and KDIGO systems, respectively. The KDIGO classification categorized 121 patients (8{\%}) who were placed in the AKIN 0 category, whereas the pRIFLE system categorized 74 (5{\%}) in KDIGO 0 and 200 (14{\%}) in AKIN 0 stages as having an AKI. The overall mortality rate was 3.9{\%}. The KDIGO stage III (odds ratio [OR], 18.8; 95{\%} confidence interval [CI], 9.6 to 36.6, p <0.001), the AKIN stage III (OR, 38.3; 95{\%} CI, 20.6 to 70.9, p <0.001), and pRIFLE failure group (OR, 13.6, 95{\%} CI, 7 to 26.3; p <0.001) were associated with increased mortality. Conclusions The pRIFLE system was the most sensitive test in detecting AKI, and this was especially so in the infant age group and also in the early identification of AKI in low-risk patients. The AKIN system was more specific and detected mostly high-risk patients across all age groups. The KDIGO classification system fell between pRIFLE and AKIN in performance. All three had increasing severity of AKI associated with mortality.",
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AU - Tóth, Roland

AU - Cserép, Zsuzsanna

AU - Alexander, Stephen I.

AU - Breuer, Tamás

AU - Sápi, Erzsébet

AU - Szatmári, A.

AU - Székely, Edgár

AU - Gál, J.

AU - Székely, Andrea

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N2 - Background The pediatric-modified Risk, Injury, Failure and Loss, and End-Stage (pRIFLE) criteria and a different but conceptually similar system termed Acute Kidney Injury Network (AKIN) were created to standardize the definition of acute kidney injury (AKI) in children. Kidney Disease: Improving Global Outcomes (KDIGO) currently recommends a combination of AKIN and pRIFLE in AKI. This study aimed to compare the three classifications for predicting AKI in pediatric patients undergoing cardiac operations. Methods We analyzed the prospectively collected data of 1,489 consecutive pediatric patients undergoing cardiac operations between January 2004 and December 2008. AKI presence and severity was assessed for each classification using the change in serum creatinine and estimated creatinine clearance levels calculated by the Schwartz equation. Results AKI was present in 285 (20%), 481 (34%), and 409 (29%) patients according to the AKIN, pRIFLE, and KDIGO systems, respectively. The KDIGO classification categorized 121 patients (8%) who were placed in the AKIN 0 category, whereas the pRIFLE system categorized 74 (5%) in KDIGO 0 and 200 (14%) in AKIN 0 stages as having an AKI. The overall mortality rate was 3.9%. The KDIGO stage III (odds ratio [OR], 18.8; 95% confidence interval [CI], 9.6 to 36.6, p <0.001), the AKIN stage III (OR, 38.3; 95% CI, 20.6 to 70.9, p <0.001), and pRIFLE failure group (OR, 13.6, 95% CI, 7 to 26.3; p <0.001) were associated with increased mortality. Conclusions The pRIFLE system was the most sensitive test in detecting AKI, and this was especially so in the infant age group and also in the early identification of AKI in low-risk patients. The AKIN system was more specific and detected mostly high-risk patients across all age groups. The KDIGO classification system fell between pRIFLE and AKIN in performance. All three had increasing severity of AKI associated with mortality.

AB - Background The pediatric-modified Risk, Injury, Failure and Loss, and End-Stage (pRIFLE) criteria and a different but conceptually similar system termed Acute Kidney Injury Network (AKIN) were created to standardize the definition of acute kidney injury (AKI) in children. Kidney Disease: Improving Global Outcomes (KDIGO) currently recommends a combination of AKIN and pRIFLE in AKI. This study aimed to compare the three classifications for predicting AKI in pediatric patients undergoing cardiac operations. Methods We analyzed the prospectively collected data of 1,489 consecutive pediatric patients undergoing cardiac operations between January 2004 and December 2008. AKI presence and severity was assessed for each classification using the change in serum creatinine and estimated creatinine clearance levels calculated by the Schwartz equation. Results AKI was present in 285 (20%), 481 (34%), and 409 (29%) patients according to the AKIN, pRIFLE, and KDIGO systems, respectively. The KDIGO classification categorized 121 patients (8%) who were placed in the AKIN 0 category, whereas the pRIFLE system categorized 74 (5%) in KDIGO 0 and 200 (14%) in AKIN 0 stages as having an AKI. The overall mortality rate was 3.9%. The KDIGO stage III (odds ratio [OR], 18.8; 95% confidence interval [CI], 9.6 to 36.6, p <0.001), the AKIN stage III (OR, 38.3; 95% CI, 20.6 to 70.9, p <0.001), and pRIFLE failure group (OR, 13.6, 95% CI, 7 to 26.3; p <0.001) were associated with increased mortality. Conclusions The pRIFLE system was the most sensitive test in detecting AKI, and this was especially so in the infant age group and also in the early identification of AKI in low-risk patients. The AKIN system was more specific and detected mostly high-risk patients across all age groups. The KDIGO classification system fell between pRIFLE and AKIN in performance. All three had increasing severity of AKI associated with mortality.

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