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Subclinical acute kidney injury is associated with adverse outcomes in critically ill neonates and children

BACKGROUND: Research on acute kidney injury (AKI) has focused on identifying early biomarkers. However, whether AKI could be diagnosed in the absence of the classic signs of clinical AKI and whether the condition of subclinical AKI, identified by damage or functional biomarkers in the absence of oli...

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Autores principales: Fang, Fang, Hu, Xiaohan, Dai, Xiaomei, Wang, Sanfeng, Bai, Zhenjiang, Chen, Jiao, Pan, Jian, Li, Xiaozhong, Wang, Jian, Li, Yanhong
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6180629/
https://www.ncbi.nlm.nih.gov/pubmed/30305134
http://dx.doi.org/10.1186/s13054-018-2193-8
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author Fang, Fang
Hu, Xiaohan
Dai, Xiaomei
Wang, Sanfeng
Bai, Zhenjiang
Chen, Jiao
Pan, Jian
Li, Xiaozhong
Wang, Jian
Li, Yanhong
author_facet Fang, Fang
Hu, Xiaohan
Dai, Xiaomei
Wang, Sanfeng
Bai, Zhenjiang
Chen, Jiao
Pan, Jian
Li, Xiaozhong
Wang, Jian
Li, Yanhong
author_sort Fang, Fang
collection PubMed
description BACKGROUND: Research on acute kidney injury (AKI) has focused on identifying early biomarkers. However, whether AKI could be diagnosed in the absence of the classic signs of clinical AKI and whether the condition of subclinical AKI, identified by damage or functional biomarkers in the absence of oliguria or increased serum creatinine (sCr) levels, is clinically significant remains to be elucidated in critically ill children. The aims of the study were to investigate the associations between urinary cystatin C (uCysC) levels and AKI and mortality and to determine whether uCysC-positive subclinical AKI is associated with adverse outcomes in critically ill neonates and children. METHODS: In this prospective cohort study, uCysC levels were serially measured during the first week after intensive care unit (ICU) admission in a heterogeneous group of patients (n = 510) presenting to a tertiary neonatal and pediatric ICU. The diagnosis of neonatal AKI that developed during the first week after admission was based on neonatal KDIGO criteria or sCr >1.5 mg/dL, and pediatric AKI was based on Kidney Disease: Improving Global Outcomes (KDIGO) criteria. The term “uCysC(−)” or “uCysC(+)”, indicating the absence or presence of tubular injury, was defined by the optimal peak uCysC cutoff value for predicting ICU mortality. RESULTS: The initial and peak uCysC levels were significantly associated with AKI and mortality, and had an area under the receiver operating characteristic curve of 0.76 and 0.81, respectively, for predicting mortality. At the optimal cutoff value of 1260 ng/mg uCr, the peak uCysC displayed sensitivity of 79.2% and specificity of 72.3% for predicting mortality. Among all patients, 130 (25.5%) developed uCysC(+)/AKI(−) status during the first week after admission. The adjusted odds ratio for patients with uCysC(+)/AKI(−) status in association with an increased risk of mortality compared with that for patients with uCysC(−)/AKI(−) was 9.34 (P < 0.001). Patients with uCysC(+)/AKI(−) spent 2.8 times as long in the ICU as those with uCysC(−)/AKI(−) (P < 0.001). CONCLUSIONS: Both initial and peak uCysC levels are associated with AKI and mortality and are independently predictive of mortality in critically ill neonates and children. Subclinical AKI may occur without detectable loss of kidney function, and uCysC-positive subclinical AKI is associated with worse clinical outcomes in this population. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s13054-018-2193-8) contains supplementary material, which is available to authorized users.
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spelling pubmed-61806292018-10-18 Subclinical acute kidney injury is associated with adverse outcomes in critically ill neonates and children Fang, Fang Hu, Xiaohan Dai, Xiaomei Wang, Sanfeng Bai, Zhenjiang Chen, Jiao Pan, Jian Li, Xiaozhong Wang, Jian Li, Yanhong Crit Care Research BACKGROUND: Research on acute kidney injury (AKI) has focused on identifying early biomarkers. However, whether AKI could be diagnosed in the absence of the classic signs of clinical AKI and whether the condition of subclinical AKI, identified by damage or functional biomarkers in the absence of oliguria or increased serum creatinine (sCr) levels, is clinically significant remains to be elucidated in critically ill children. The aims of the study were to investigate the associations between urinary cystatin C (uCysC) levels and AKI and mortality and to determine whether uCysC-positive subclinical AKI is associated with adverse outcomes in critically ill neonates and children. METHODS: In this prospective cohort study, uCysC levels were serially measured during the first week after intensive care unit (ICU) admission in a heterogeneous group of patients (n = 510) presenting to a tertiary neonatal and pediatric ICU. The diagnosis of neonatal AKI that developed during the first week after admission was based on neonatal KDIGO criteria or sCr >1.5 mg/dL, and pediatric AKI was based on Kidney Disease: Improving Global Outcomes (KDIGO) criteria. The term “uCysC(−)” or “uCysC(+)”, indicating the absence or presence of tubular injury, was defined by the optimal peak uCysC cutoff value for predicting ICU mortality. RESULTS: The initial and peak uCysC levels were significantly associated with AKI and mortality, and had an area under the receiver operating characteristic curve of 0.76 and 0.81, respectively, for predicting mortality. At the optimal cutoff value of 1260 ng/mg uCr, the peak uCysC displayed sensitivity of 79.2% and specificity of 72.3% for predicting mortality. Among all patients, 130 (25.5%) developed uCysC(+)/AKI(−) status during the first week after admission. The adjusted odds ratio for patients with uCysC(+)/AKI(−) status in association with an increased risk of mortality compared with that for patients with uCysC(−)/AKI(−) was 9.34 (P < 0.001). Patients with uCysC(+)/AKI(−) spent 2.8 times as long in the ICU as those with uCysC(−)/AKI(−) (P < 0.001). CONCLUSIONS: Both initial and peak uCysC levels are associated with AKI and mortality and are independently predictive of mortality in critically ill neonates and children. Subclinical AKI may occur without detectable loss of kidney function, and uCysC-positive subclinical AKI is associated with worse clinical outcomes in this population. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s13054-018-2193-8) contains supplementary material, which is available to authorized users. BioMed Central 2018-10-10 /pmc/articles/PMC6180629/ /pubmed/30305134 http://dx.doi.org/10.1186/s13054-018-2193-8 Text en © The Author(s). 2018 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research
Fang, Fang
Hu, Xiaohan
Dai, Xiaomei
Wang, Sanfeng
Bai, Zhenjiang
Chen, Jiao
Pan, Jian
Li, Xiaozhong
Wang, Jian
Li, Yanhong
Subclinical acute kidney injury is associated with adverse outcomes in critically ill neonates and children
title Subclinical acute kidney injury is associated with adverse outcomes in critically ill neonates and children
title_full Subclinical acute kidney injury is associated with adverse outcomes in critically ill neonates and children
title_fullStr Subclinical acute kidney injury is associated with adverse outcomes in critically ill neonates and children
title_full_unstemmed Subclinical acute kidney injury is associated with adverse outcomes in critically ill neonates and children
title_short Subclinical acute kidney injury is associated with adverse outcomes in critically ill neonates and children
title_sort subclinical acute kidney injury is associated with adverse outcomes in critically ill neonates and children
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6180629/
https://www.ncbi.nlm.nih.gov/pubmed/30305134
http://dx.doi.org/10.1186/s13054-018-2193-8
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