الفهرس 
Critically ill childrenOnly 14 pages are availabe for public view
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Abstract
Acute kidney injury (AKI) is highly prevalent in PICU critically ill
patients, leading to significant mortality and morbidity, reduced quality of
life and high short- and long-term health-care costs.
Early detection of AKI in critically ill children in an ICU setting is
often a challenging situation as diagnosis is mainly based on clinical
indications (oliguria/anuria) and/or rise of serum creatinine, which is a late
phenomenon. In addition, fluid overload, use of nephrotoxic medications
and need of mechanical ventilation often complicate the condition and
contribute to mortality.
Therefore, it becomes imperative to apply some other clinical (RAI)
and biochemical marker (serum cystatin C) for early detection who is at
risk or who are developing AKI so that they can be treated earlier or more
intensively to limit subsequent problems as much as possible.
The RAI has been validated in prediction for severe AKI, need
of RRT, mechanical ventilation and mortality. The renal angina index was
proposed to predict AKI in critically ill children on the basis of kidney
injury (change of SCr from baseline (SCr/Base)or fluid overload) and
patient risk factors (ICU admission, stem cell transplantation, ventilation
and inotropes).
In this study the primary objective to investigate the predictive
ability of RAI and cystatin C on day 0 for the development of severe AKI
(stages 2 and 3 KDIGO classification at day 3) and secondary outcomes for
prediction of need of RRT, need of mechanical ventilation, vasoactive drug
use and mortality. In addition, diagnostic accuracy of a combination of RAI
and serum cystatin C in predicting severe AKI was also analysed.
Summary
131
To achieve this target, this study enrolled 93 critically ill patients,
one month to 18 years old, admitted to the PICU at Menoufia University
Hospital between May 2020 and May 2021. Patients with chronic or any
kidney disease, Patients who receive renal replacement therapy, Patients
discharged from PICU before 3 days were excluded from the study.
On third day of admission, Enrolled patients were sub grouped
according to the presence of AKI according to KIDGO guidelines to
patients with AKI group (n=66) and no AKI group (n=27).
All children incorporated in the study were subjected to: careful
history taking, thorough clinical examination and laboratory investigations,
serum cystatin C was done, pSOFA score was calculated within 24hrs of
admission for each patient, PRISM III, PIM2 score to detect mortality rate.
Clinical outcomes, such as need of vasoactive drug, duration of
mechanical ventilation, need for renal replacement therapy and mortality
were recorded.
RAI score was determined on first day of PICU admission (Day 0
RAI). RAI was calculated from multiply risk score × injury score. Renal
angina index ≥8 was considered fulfillment of renal angina.
Prediction of Day 3–AKI by the RAI, cystatin C and after
incorporation of biomarkers with RAI was analysed.
We founded that AKI is common among critically ill children with
incidence of (71%).The incidence of sever AKI (stage 2, 3 KIDGO) was
53.7%.
In our study, ROC curve analysis showed fair performance of RAI in
predicting sever AKI, RRT, need of mechanical ventilation, vasoactive
drug use and mortality.
Summary
132
We found ROC curve analysis showed fair performance of serum
cystatin C in predicting AKI and mortality.
There was a significant correlation between serum cystatin C levels
with RAI and AKI.
The results showed significant correlations between RAI and serum
cystatin C, creatinine, AKI and mortality scores.
AKI patients had significantly higher serum cystatin C levels than
non-AKI patients.
Mechanical ventilation use; RRT, vasoactive drug administration
and mortality rate were significantly higher in patients with AKI than those
with no AKI. Higher proportion of children with positive RAI developed
severe AKI, compared to negative RAI group.
Multivariate stepwise regression analysis demonstrated that RAI
was an independent predictor of AKI.
Incorporation of cystatin C with RAI increases AUC, sensitivity and
specificity of prediction of AKI.
We conclude that risk stratification using renal angina will aid with
the prediction of severe AKI and that renal angina prodrome, in
conjunction with AKI biomarker measurement, may reliably differentiate
patients who will Kidney be responsive to appropriate restorative therapy
from those will progress to severe subsequent AKI.