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Assessment of acute kidney injury with modified RIFLE criteria in critically ill pediatric burn patients
Critical Care volume 13, Article number: P265 (2009)
The objective of the present study was to evaluate the incidence, risk factors and outcome associated with acute kidney injury (AKI) as defined by the modified pediatric version of RIFLE criteria (pRIFLE) in children with severe burn injury.
The retrospective, descriptive cohort study included 123 patients admitted for more than 24 hours to a burn pediatric ICU from 2006 to 2008. Burn injury severity was estimated using the total body surface area burn (TBSA%), severity of illness was estimated using the Pediatric Risk of Mortality (PRISM) score. The pRIFLE criteria were applied and the patients were assigned to the appropriate pRIFLE stratum (Risk, Injury, Failure) if they fulfilled either estimated creatinine clearance, urine output criteria, or both.
The incidence of AKI was 40.7%, maximum RIFLE class Risk, class Injury and class Failure occurred in 50%, 36% and 18%, respectively. Patients with maximum RIFLE class Risk, Injury and Failure had ICU mortality rates of 0%, 5.6% and 57.1%, respectively, compared with 1.4% for patients without AKI. We observed statistically significant differences between the patients with AKI and those without AKI in the following parameters: TBSA (41.2 ± 17.7% vs. 24.2 ± 14.6%, P < 0.001), admission PRISM (8.6 ± 6.4 vs. 4.8 ± 3.4, P < 0.01), number of surgical procedures (3.7 ± 2.9 vs. 1.5 ± 1.5, P < 0.001), occurrence of abdominal compartment syndrome (18% vs. 0%, P < 0.001), length of mechanical ventilation (22.3 ± 27.6 days vs. 7.1 ± 11.4 days, P < 0.001) and length of ICU stay (37 ± 30.1 days vs. 14.6 ± 13.9 days, P < 0.001). Logistic regression analysis indicated that PRISM score (OR = 1.1, 95% CI = 1.0 to 1.2; P = 0.05) and TBSA (OR = 1.06, 95% CI = 1.0 to 1.1; P < 0.001) were independent risk factors for AKI in pediatric burn patients.
AKI estimated by pRIFLE criteria occurs in major pediatric burns, and failure was associated with increased mortality. Patients with AKI had higher admission burn and illness severity, increased incidence of abdominal compartment syndrome, more operations, and had increased duration of mechanical ventilation and length of ICU stay. AKI is a marker of increased resource utilization and risk for adverse outcomes after burn injury in children.
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Palmieri, T., Lavrentieva, A. & Greenhalgh, D. Assessment of acute kidney injury with modified RIFLE criteria in critically ill pediatric burn patients. Crit Care 13, P265 (2009). https://doi.org/10.1186/cc7429
- Acute Kidney Injury
- Compartment Syndrome
- Abdominal Compartment Syndrome
- Total Body Surface Area
- Estimate Creatinine Clearance