Comparative Study of Akin Staging and Pediatric - Risk, Injury, Failure, Loss, End-stage Kidney Classification in Identifying Acute Kidney Injury in Critically Ill Children
Journal Title: INTERNATIONAL JOURNAL OF SCIENTIFIC STUDY - Year 2017, Vol 5, Issue 2
Abstract
Introduction: Acute kidney injury (AKI) is a common comorbidity in critically ill children, associated with an increased risk of morbidity and mortality. Modern definitions of AKI based on changes in serum creatinine (Cr) and urine output (UO) are the risk, injury, failure, loss, end-stage kidney (RIFLE) classification, and AKI network (AKIN) staging. Aims and Objectives: The aim of this study was to compare AKIN staging and pediatric RIFLE (p-RIFLE) classification of AKI in critically ill children admitted to Paediatric Intensive Care Unit (PICU) at Institute of Child Health and Research Centre (ICH and RC), Madurai. Materials and Methods: A prospective observational study done in children 1 month – 12 years of age, admitted to PICU at ICH and RC, Madurai, over a period of 1 year. Demographic information, comorbidities, and serial serum Cr values were collected. UO was measured 6th hourly. AKI was defined by AKIN staging and p-RIFLE classification. Results analyzed using SPSS version 19. Results: In our study, total of 342 children were enrolled. 106 children had AKI by AKIN staging and 103 had AKI by p-RIFLE criteria, incidence being 31% and 30.1%, respectively. According to AKIN staging, Stage 1 included 43 (40.6%), Stage 2 included 28 (26.4%), Stage 3 included 35 (33%) cases. According to p-RIFLE classification, risk category included 35 (34%), injury category included 31 (30.1%), and failure category included 37 (35.9%) cases. The mortality rate was 42.5% (AKIN staging) and 43.6% (p-RIFLE classification). Mortality among the stages was 34.9%, 39.3%, and 54.3% in AKIN Stage 1, 2, and 3, respectively, with odds ratio of 0.59, 0.84, and 2.06, respectively. According to p-RIFLE, mortality was 37.1%, 38.7%, 54% in risk, injury, and failure class, respectively. There was no difference between AKIN staging and p-RIFLE classification in identifying AKI cases and predicting mortality. Conclusion: Both criteria correlate highly with outcome and demonstrate excellent inter-stage discrimination. Both were good predictors of mortality.
Authors and Affiliations
V Jakanattane, M Kulandaivel
Keywords
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