An assessment of acute kidney injury with modified RIFLE criteria in pediatric patients with severe burns.
OBJECTIVE
To apply the modified pediatric RIFLE criteria for severity of acute kidney injury (AKI) to pediatric burn ICU patients and to evaluate the overall incidence of AKI, risk factors for AKI and influence of AKI on outcome.


METHODS
Retrospective, descriptive cohort study.


METHODS
10-bed burn PICU facility.


METHODS
All consecutive patients with a burn injury of 10% or more of total body surface area percentage (TBSA, %) admitted during a 2 year period.


RESULTS
Data of 123 patients were studied. The incidence of AKI was 45.5%. Patients with AKI tended to have higher mortality than those without AKI (p = 0.057). All nonsurvivors attained pRIFLE AKI by combination of serum creatinine and urine output criteria. Patients with a more severe form of AKI (Failure and Injury) as well as patients with late AKI had more episodes of sepsis as compared to patients with early AKI and the Risk category of AKI. Logistic regression analysis indicated that PRISM score and TBSA were the independent risk factors for acute kidney injury in pediatric burn patients; the presence of sepsis and septic shock were the independent risk factors for the Failure class of AKI.


CONCLUSIONS
We observed a high incidence of AKI in the burn PICU population. Sepsis seems to contribute to the development of the Failure class of AKI. Maximum Failure class of AKI is associated with high mortality.
Palmieri
Tina
T
Shriners Hospital for Children Northern California, Burn ICU, Sacramento, USA.
Lavrentieva
Athina
A
Greenhalgh
David
D
D000208:Acute Disease; D002056:Burns / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D002648:Child; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D051437:Renal Insufficiency / Q000175:diagnosis* / Q000453:epidemiology* / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires