Publications
Evaluating the impact of change of the reference value of serum creatinine in the diagnosis, staging and outcome of acute kidney injury in critically ill children: an exploratory study
Shiri S, Joseph S, Lalitha AV, Devanath A, Thomas T, Vasudevan A Background: The current definition of acute kidney injury (AKI) using Kidney Disease Improving Global Outcomes (KDIGO) does not account for within-subject biological variation or reference change value (RCV) of serum creatinine (sCr),which may affect its reliability. The aim of this study was to derive and estimate the reference change value of sCr in children and evaluate the impact of using the reference change value-optimized creatinine criteria (KDIGORCV) on the burden, severity, and outcome of AKI compared to KDIGO creatinine criteria.
Methods: The reference change value of sCr based on age and initial sCr was derived from data regarding 420 children without risk factors for AKI (derivation cohort). In a cohort of 394 children admitted to the pediatric intensive care unit (PICU) (test cohort), AKI staging was done by KDIGO and KDIGORCV. The burden and outcomes of AKI by KDIGORCV were compared with AKI, as assessed by KDIGO criteria.
Results: In the derivation cohort (n = 420), our analysis revealed that the younger the age and the lower the sCr, the higher the variability of sCr, with the highest reference change value in the 1 month to 1 year age group (12.1%;median sCr 0.36 mg/dL). In the test cohort (n = 394), the burden of AKI was lower by 15.7% with KDIGORCV (n = 102 [25.8%]) compared to KDIGO (n = 163 [41.5%]). Approximately 75% of stage I and 23% of stage II cases of AKI as classified by KDIGO were reclassified as no AKI using KDIGORCV. Although cases of AKI classified by KDIGORCV were similar in morbidity and mortality to cases of AKI classified by KDIGO, those reclassified as no AKI by KDIGORCV (n = 61) had higher morbidity and mortality compared to no AKI by KDIGO (n = 231; p = 0.001).
Conclusion: Reference change value was highest in younger children with lower sCr. While AKI classified by KDIGORCV was similar in morbidity and mortality to AKI classified by KDIGO, there is a possibility of missing AKI cases with KDIGORCV.
