Impact of Severe Sepsis on Serum and Urinary Biomarkers of Acute Kidney Injury in Critically Ill Children: An Observational Study

2013 ◽  
Vol 35 (1-3) ◽  
pp. 172-176 ◽  
Author(s):  
Matteo Di Nardo ◽  
Alessio Ficarella ◽  
Zaccaria Ricci ◽  
Rosa Luciano ◽  
Francesca Stoppa ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Severe Sepsis ◽  
Observational Study ◽  
Critically Ill ◽  
Kidney Injury ◽  
Urinary Biomarkers ◽  
Critically Ill Children

scholarly journals Derivation and Validation of Urinary TIMP-1 for Prediction of Acute Kidney Injury and Mortality in Critically Ill Children

2021 ◽  
Author(s):  
Hui Huang ◽  
Qiang Lin ◽  
Xiaomei Dai ◽  
Jiao Chen ◽  
Zhenjiang Bai ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Critically Ill ◽  
Kidney Injury ◽  
Pediatric Intensive Care ◽  
Urinary Biomarkers ◽  
Critically Ill Children ◽  
High Morbidity ◽  
Predictive Values ◽  
Derivation Cohort ◽  
Prospective Cohorts

Abstract Background: Acute kidney injury (AKI) is associated with high morbidity and mortality. Multiple urinary biomarkers have been identified to associate with the prediction of AKI and outcomes. However, the accuracy of these urinary biomarkers for AKI and associated outcomes has not been clearly defined, especially in heterogeneous populations. The aims of the study were to compare the ability of 10 existing or potential urinary biomarkers for prediction of AKI and pediatric intensive care unit (PICU) mortality, and identify and validate the best biomarker of urinary tissue inhibitor of metalloproteinases-1 (uTIMP-1) for early prediction in heterogeneous critically ill children.Methods: A derivation-validation approach with separate critically ill cohorts was designed. We first conducted a prospective cohort study to determine the ability of 10 candidate urinary biomarkers serially measured in 123 children during the first 7 days of PICU stay and identify the best biomarker for predicting AKI and PICU mortality (derivation study). The best biomarker of uTIMP-1 from derivation was validated in a separate cohort of 357 critically ill children (validation study). AKI diagnosis was based on KDIGO classification with serum creatinine and urine output.Results: In the derivation cohort, 17 of 123 (13.8%) children developed AKI stage 3 or died during PICU stay, and both the initial and peak uTIMP-1 displayed the highest AUC of 0.87 (0.79-0.94) and 0.90 (0.84-0.96), respectively, for predicting AKI stage 3 or death. In the validation cohort, 47 of 357 (13.2%) developed AKI during the first week after admission, and 38 (10.6%) died during PICU stay. The initial uTIMP-1 level was validated to be independently associated with AKI (AOR=1.88, P=0.001), severe AKI (AOR=2.35, P<0.001), AKI stage 3 (AOR=2.87, P<0.001) and PICU mortality (AOR=1.92, P=0.019) after adjustment for potential confounders. The predictive values of uTIMP-1 for AKI, severe AKI, AKI stage 3 and PICU mortality were 0.82 (0.75-0.88), 0.84 (95%CI 0.77-0.91), 0.87 (0.81-0.94) and 0.83 (0.76-0.89), respectively.Conclusions: Urinary TIMP-1 level has been identified and validated to be independently associated with AKI and PICU mortality in independent prospective cohorts, and may be an early potential indicator of AKI and PICU mortality in critically ill children.

OR007: Nutrition Support Guidelines in Critically Ill Children with Acute Kidney Injury

2015 ◽  
Vol 34 ◽  
pp. S2
Author(s):  
J.C. Silva ◽  
U.G. Kyle ◽  
M. Treviño ◽  
J.L. Lusk ◽  
G. Dardon ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Critically Ill ◽  
Kidney Injury ◽  
Nutrition Support ◽  
Critically Ill Children ◽  
Support Guidelines

scholarly journals Urinary CXCL10 is Associated with Acute Kidney Injury and Sepsis, and Predicts Mortality in Critically Ill Children

2020 ◽  
Author(s):  
Hui Huang ◽  
Huiting Zhou ◽  
Wenwen Wang ◽  
Xiaomei Dai ◽  
Wenjing Li ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Critically Ill ◽  
Inflammatory Mediator ◽  
Kidney Injury ◽  
Pediatric Intensive Care ◽  
Critically Ill Children ◽  
Surviving Sepsis Campaign ◽  
Predictive Values ◽  
Specific Setting ◽  
Potential Indicator

Abstract Background: Acute kidney injury (AKI) biomarkers are often susceptible to confounding factors, limiting their utility as a specific biomarker, in the prediction of AKI, especially in heterogeneous population. The urinary CXC motif chemokine 10 (uCXCL10), as an inflammatory mediator, has been proposed to be a biomarker for AKI in a specific setting. Whether uCXCL10 is associated with AKI and predicts AKI in critically ill patients remains unclear. The aims of the study were to investigate clinical variables potentially associated with uCXCL10 levels and determine the associations of uCXCL10 with AKI, sepsis and PICU mortality in critically ill children, as well as its predictive values of aforementioned issues. Methods: Urinary CXCL10 levels were serially measured in a heterogeneous group of children during the first week after pediatric intensive care unit (PICU) admission. AKI diagnosis was based on the criteria of Kidney Disease: Improving Global Outcomes with serum creatinine and urine output. Sepsis was diagnosed according to surviving sepsis campaign international guidelines for children. Mortality was defined as all-cause death occurring during the PICU stay.Results: Among 342 critically ill children, 52 (15.2%) developed AKI during the first week after PICU admission, and 132 (38.6%) were diagnosed as sepsis and 30 (12.3%) died during PICU stay. Both the initial and peak values of uCXCL10 remained independently associated with AKI with adjusted odds ratios (AORs) of 1.791 (P = 0.010) and 2.002 (P = 0.002), sepsis with AORs of 1.679 (P = 0.003) and 1.752 (P = 0.002), septic AKI with AORs of 3.281 (P <0.001) and 3.172 (P <0.001), and PICU mortality with AORs of 2.779 (P = 0.001) and 3.965 (P <0.001), respectively. The AUCs of the initial uCXCL10 for predicting AKI, sepsis, septic AKI, and PICU mortality were 0.63 (0.53-0.72), 0.62 (0.56-0.68), 0.75 (0.64-0.87), and 0.77 (0.68-0.86), respectively. The AUCs for prediction by using peak uCXCL10 were as follows: AKI 0.65 (0.56-0.75), sepsis 0.63 (0.57-0.69), septic AKI 0.76 (0.65-0.87), and PICU mortality 0.84 (0.76-0.91).Conclusions: Urinary CXCL10 is independently associated with AKI and sepsis, and may be a potential indicator of septic AKI and PICU mortality in critically ill children.

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