Aims & Objectives:
To study the incidence and outcome of two classifications (p-RIFLE and AKIN) for predicting acute kidney injury (AKI) by using modified Schwartz formula in the pediatric intensive care unit.
Setting: Pediatric Critical Care Division of a tertiary care institute. Subjects: Children aged ≤12 years admitted to PICU from Jan-2016 to Dec-2016. Intervention: We analyzed the prospectively collected data of 512 admissions. AKI presence and severity was assessed for each classification using the change in serum creatinine and estimated creatinine clearance (eCCl) levels calculated by the modified Schwartz formula (=0.413xLength in cm / SCr in mg/dl). For baseline eCCl, the lowest value of SCr in the three months preceding the admission. If no previous SCr was available, the patient was assigned an eCCl of 100 ml/min/1.73m2.
Median (IQR) of age was (23.4,5 – 120) months and male: female is 307:205. AKI was present in 424 (82.8%; R-34.4%, I-46%, F-19.6%) and 379 (74%; I-28.2%, II-35%, III-36.7%) according to p-RIFLE and AKIN criteria respectively. Intraclass correlation between two system for identification of AKI was 83.3% (95%CI 80% to 86%, Cronbach’s Alpha=0.833) and for severity of AKI was 93.2% (95%CI 92% to 94.3%, Cronbach’s Alpha=0.932). Progressively higher mortality at each AKI severity stage was demonstrated by p-RIFLE (R-21%; I-28%; F-40%) and AKIN (I-21%; II-24%; III-40%).
Both p-RIFLE and AKIN criteria show good consistency in the identification and excellent consistency in severity classification of AKI. p-RIFLE shows early detection of AKI and AKIN shows the over-diagnosis of the severe type of AKI.