Acute kidney injury in the paediatric intensive care unit: identification by modified
WF Hui, Winnie KY Chan, TY Miu
Department of Paediatrics, Queen
Elizabeth Hospital, Jordan, Hong Kong
Objective. To evaluate the prevalence and outcome of acute kidney injury
in paediatric intensive care units using the modified RIFLE score
Design. Historical cohort study.
Setting. A paediatric intensive care unit in a regional Hong Kong hospital.
Patients. All paediatric patients aged 1 month to 18 years admitted to a
local paediatric intensive care unit in the years 2005 to 2007.
Main outcome measures. For every paediatric intensive care unit admission, acute kidney
injury was classified according to the pRIFLE criteria (“R” for risk,
“I” for injury, “F” for failure, “L” for loss, and “E” for end-stage).
Prevalence and outcome of acute kidney injury were therefore
categorised according to the pRIFLE staging.
Results. A total of 140 such patient admissions constituted the study
population. The point prevalence of acute kidney injury in
these patients on admission was 46% (n=59), whilst 56% (n=78)
endured acute kidney injury at some time during their paediatric
intensive care unit stay. Worsening of pRIFLE grading during
their intensive care unit admission was observed in 20% of the
patients who had no acute kidney injury on admission, in 30%
of those who had an initial “R” grade, and in 40% of those who
had an initial “I” grade of acute kidney injury. Overall mortality
in this cohort was 12%, which was significantly higher among
patients with acute kidney injury. Having acute kidney injury of
grade “F” on admission to the paediatric intensive care unit was
an independent predictor of mortality (hazard ratio=5.94; 95%
confidence interval, 1.06-33.36; P=0.043).
Conclusion. Among critically ill paediatric patients, the pRIFLE score serves
as a suitable classification of acute kidney injury when stratified
according to clinical severity. It also provides prognostic
information on mortality and renal outcomes.
Hong Kong Med J 2013;19:13-9
Key words: Acute kidney injury; Child; Intensive care
units, pediatric; Outcome assessment
(health care); Severity of illness index