Volume 19 Supplement 1
Impact of kidney injury on fluid overload and impaired oxygenation
© Arikan et al.; licensee BioMed Central Ltd. 2015
Published: 16 March 2015
Severity of acute kidney injury (AKI) and fluid overload (FO) are not incorporated into current severity of illness measures and are invisible to the practitioner. The causal relationship and timing between AKI and FO and oxygenation is not clear. The Fluid Overload Kidney Injury Score (FOKIS) is a daily score incorporating subscores for AKI (pRIFLE (creatinine (Cr) and urine output (UOP))), FO (total fluid (in - out) / ICU admission weight) >15% in five percentile increments, and exposure to nephrotoxic medications. We previously reported that FOKIS outperforms PRISM in mortality prediction in our pediatric intensive care unit (PICU). We hypothesized that patients with AKI on admission to the PICU developed worse fluid overload and in turn worse oxygenation.
We prospectively calculated daily FOKIS scores and subscores (Cr, UOP, FO) in PICU patients. We excluded patients with <7 day stays in order to properly explore the association between timing of AKI and FO and oxygenation by oxygenation index (OI).
4 to 7
maxOI, median (IQR)
7.4 (5.9 to 16.4)
11.1 (6.2 to 23.6)
16.4 (7.3 to 29.6)
14.2 (10 to 38.7)
In PICU patients, admission or day 3 AKI alone did not predict maxFO. A composite score that includes both AKI and FO parameters correlated with OI and discriminated survivors from nonsurvivors. FO seems to result from combination of increased fluid exposure with underlying AKI but cannot fully be explained by oliguria in pediatric patients.
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