Background

The consensus definition of acute kidney injury (AKI) has evolved since developing the original multiple organ dysfunction syndrome (MODS) definitions. Whether or not risk for adverse short- and long-term outcomes can be identified using the refined AKI criteria in the setting of MODS has not been studied. We hypothesize that incorporation of Kidney Disease: Improving Global Outcome (KDIGO) AKI criteria into existing MODS definitions will have a higher association with major adverse kidney events at 30 days (MAKE30) and will increase the number of patients with MODS.

Methods

Post hoc analysis of 410 children admitted to a tertiary care pediatric intensive care unit (PICU) was conducted. MODS was defined using two existing criteria (Goldstein and Proulx) during the first 7 days following ICU admission and then modified by replacement of the kidney injury criteria using the KDIGO AKI definitions (G′ and P′).

Results

MAKE30 occurred in 65 of 410 (16%) children. After substituting KDIGO kidney injury criteria, identification of MAKE30 increased from 46 children (71%) to 53 (82%) and 29 children (45%) to 43 (66%) for the Goldstein and Proulx criteria, respectively. Additionally, identification of MODS increased from 194 (47%) by Goldstein to 224 (55%) by G′ and 95 children (23%) by Proulx to 132 (32%) by P′.

Conclusions

Substituting KDIGO AKI criteria into existing MODS criteria increases the sensitivity for major adverse kidney events as well as the identification of MODS, improving the detection of children at risk for long-term adverse renal outcomes.

中文翻译：

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共识性急性肾损伤标准整合确定了多器官功能障碍综合征后面临长期肾功能障碍风险的儿童

背景

自制定最初的多器官功能障碍综合征 (MODS) 定义以来，急性肾损伤 (AKI) 的共识定义不断发展。尚未研究在 MODS 情况下是否可以使用改进的 AKI 标准来识别不良短期和长期结果的风险。我们假设将肾脏疾病：改善全球结局 (KDIGO) AKI 标准纳入现有 MODS 定义将与 30 天时主要不良肾脏事件 (MAKE30) 具有更高的关联性，并将增加 MODS 患者的数量。

方法

对入住三级儿科重症监护病房 (PICU) 的 410 名儿童进行事后分析。MODS 在入住 ICU 后的前 7 天内使用两个现有标准（Goldstein 和 Proulx）进行定义，然后通过使用 KDIGO AKI 定义（G' 和 P'）替换肾损伤标准进行修改。

结果

410 名儿童中，有 65 名 (16%) 发生了 MAKE30。取代 KDIGO 肾损伤标准后，Goldstein 和 Proulx 标准的 MAKE30 鉴定分别从 46 名儿童 (71%) 增加到 53 名儿童 (82%)，从 29 名儿童 (45%) 增加到 43 名儿童 (66%)。此外，MODS 的鉴定从 Goldstein 的 194 名（47%）增加到 G' 的 224 名（55%），Proulx 的 95 名儿童（23%）增加到 P' 的 132 名（32%）。

结论

将 KDIGO AKI 标准替换为现有 MODS 标准可提高对主要不良肾脏事件以及 MODS 识别的敏感性，从而改善对有长期不良肾脏结局风险的儿童的检测。