title: A small post-operative rise in serum creatinine predicts acute kidney injury in children undergoing cardiac surgery.
abstract: To predict development of acute kidney injury and its outcome we retrospectively studied children having cardiac surgery. Acute kidney injury (AKI) was defined using the serum creatinine criteria of the pediatric Risk Injury Failure Loss End-Stage (pRIFLE) kidney disease definition. We tested whether a small rise (less than 50%) in creatinine on post-operative days 1 or 2 could predict a greater than 50% increase in serum creatinine within 48 h in 390 children. AKI occurred in 36% of patients, mostly in the first 4 post-operative days. Using logistic regression, significant independent risk factors for AKI were bypass time, longer vasopressor use, and a tendency for younger age. Using Cox regression, AKI was independently associated with longer intensive care unit stay and duration of ventilation. Patients whose serum creatinine did not increase on post-operative days 1 or 2 were unlikely to develop AKI (negative predictive values of 87 and 98%, respectively). Percentage serum creatinine rise on post-operative day 1 predicted AKI within 48 h (area under the curve=0.65). Our study shows that AKI after pediatric heart surgery is common and is a risk factor for poorer outcome. Small post-operative increases in serum creatinine may assist in the early prediction of AKI.
authors.affiliation: Department of Pediatrics, McGill University Health Centre, Montreal Children's Hospital, Quebec, Canada. mzaprdr@yahoo.ca
authors.forename: Michael
authors.initials: M
authors.lastname: Zappitelli
authors.forename: Pierre-Luc
authors.initials: PL
authors.lastname: Bernier
authors.forename: Richard S
authors.initials: RS
authors.lastname: Saczkowski
authors.forename: Christo I
authors.initials: CI
authors.lastname: Tchervenkov
authors.forename: Ronald
authors.initials: R
authors.lastname: Gottesman
authors.forename: Adrian
authors.initials: A
authors.lastname: Dancea
authors.forename: Ayaz
authors.initials: A
authors.lastname: Hyder
authors.forename: Omar
authors.initials: O
authors.lastname: Alkandari
mesh_terms: D000208:Acute Disease; D015415:Biomarkers / Q000097:blood; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D003404:Creatinine / Q000097:blood*; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D007674:Kidney Diseases / Q000097:blood / Q000453:epidemiology / Q000209:etiology*; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012372:ROC Curve; D012121:Respiration, Artificial; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D015854:Up-Regulation
chemical_list: D015415:Biomarkers; D003404:Creatinine