title: Influence of Acute Kidney Injury Defined by the Pediatric Risk, Injury, Failure, Loss, End-Stage Renal Disease Score on the Clinical Course of PICU Patients.
abstract: OBJECTIVE
  To evaluate the predictive value of the pediatric-modified Risk, Injury, Failure, Loss, End-stage renal disease criteria for disease course severity in patients with or without acute kidney injury admitted to a PICU.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  A 12-bed PICU at a tertiary referral center in Southern Brazil.
  
  
  METHODS
  All patients admitted to the study unit over a 1-year period.
  
  
  METHODS
  A database of all eligible patients was analyzed retrospectively.
  
  
  RESULTS
  Patients were classified by pediatric-modified Risk, Injury, Failure, Loss, End-stage renal disease score at admission and worst pediatric-modified Risk, Injury, Failure, Loss, End-stage renal disease score during PICU hospitalization. The outcomes of interest were length of PICU stay, duration of mechanical ventilation, duration of vasoactive drug therapy, and mortality. The Pediatric Index of Mortality 2 was used to assess overall disease severity at the time of PICU admission. Of 375 patients, 169 (45%) presented acute kidney injury at the time of admission and 37 developed acute kidney injury during PICU stay, for a total of 206 of 375 patients (55%) diagnosed with acute kidney injury during the study period. The median Pediatric Index of Mortality 2 score predicted a mortality rate of 9% among non-acute kidney injury patients versus a mortality rate of 16% among acute kidney injury patients (p = 0.006). The mortality of patients classified as pediatric-modified Risk, Injury, Failure, Loss, End-stage renal disease F was double that predicted by Pediatric Index of Mortality 2 (7 vs 3.2). Patients classified as having severe acute kidney injury (pediatric-modified Risk, Injury, Failure, Loss, End-stage renal disease I + F) exhibited higher mortality (14.1%; p = 0.001) and prolonged PICU length of stay (median, 7 d; p = 0.001) when compared with other patients. Acute kidney injury is a very frequent occurrence among patients admitted to PICUs.
  
  
  CONCLUSIONS
  The degree of acute kidney injury severity, as assessed by the pediatric-modified Risk, Injury, Failure, Loss, End-stage renal disease criteria, is a good predictor of morbidity and mortality in this population. Pediatric Index of Mortality 2 tends to underestimate mortality in pediatric patients with severe acute kidney injury.
authors.affiliation: 1Clinical Director, Hospital Materno Infantil Presidente Vargas, SMS, PMPA, Porto Alegre, Brazil. 2Pediatric Intensive Care Unit, Department of Pediatric Intensive Care, Hospital Moinhos de Vento, Porto Alegre, Brazil. 3Department of Pediatrics and Graduate Program in Pediatrics and Child Health, PUCRS School of Medicine, Hospital São Lucas - PUCRS, Porto Alegre, Brazil. 4Department of Pediatrics and Graduate Program in Pediatrics and Child Health, PUCRS School of Medicine, Centro Infant, Biomedical Research Institute, PUCRS, Porto Alegre, Brazil. 5Pediatric Intensive Care Unit, Department of Pediatric Intensive Care, PUCRS School of Medicine, Hospital São Lucas - PUCRS, Porto Alegre, Brazil. 6Neonatal Intensive Care Unit, Department of Pediatrics and Graduate Program in Pediatrics and Child Health, PUCRS School of Medicine, Hospital São Lucas - PUCRS, Porto Alegre, Brazil. 7Department of Pediatrics, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil. 8Department of Emergency Medicine and Pediatric Critical Care, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.
authors.forename: Felipe Cezar
authors.initials: FC
authors.lastname: Cabral
authors.forename: Pedro Celiny
authors.initials: PC
authors.lastname: Ramos Garcia
authors.forename: Rita
authors.initials: R
authors.lastname: Mattiello
authors.forename: Daiane
authors.initials: D
authors.lastname: Dresser
authors.forename: Humberto Holmer
authors.initials: HH
authors.lastname: Fiori
authors.forename: Cecilia
authors.initials: C
authors.lastname: Korb
authors.forename: Tiago Chagas
authors.initials: TC
authors.lastname: Dalcin
authors.forename: Jefferson Pedro
authors.initials: JP
authors.lastname: Piva
mesh_terms: D058186:Acute Kidney Injury / Q000401:mortality / Q000503:physiopathology*; D000293:Adolescent; D001938:Brazil; D002648:Child; D002675:Child, Preschool; D016638:Critical Illness; D005260:Female; D006304:Health Status; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data*; D007676:Kidney Failure, Chronic; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D062606:Tertiary Care Centers / Q000706:statistics & numerical data