MO1030: Aki Awareness and Survival in Paediatric Patients in a Western Romania Emergency Hospital—a 7 Years Retrospective Cohort Study
Authors: Chisavu Flavia , Gafencu Mihai , Chisavu Lazar , Stroescu Ramona , Mihaescu Adelina , Schiller Oana-Marina , Schiller Adalbert 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Acute kidney injury (AKI) is a globally increasing healthcare problem being usually associated with low awareness and high mortality. Several large studies have drawn attention to the increasing cases of AKI in the paediatric population, mostly in the neonatal setting but also in critically ill patients and young adults. It was suggested that increased awareness could lead to early diagnosis and intervention, therefore improved survival.

METHOD
We performed a retrospective cohort study in ‘Louis Turcanu’ Emergency County Hospital for Children in Timisoara, Romania. Data have been extracted from the hospital electronic database, between 1 January 2014 and 31 December 2020. The cohort included 127 457 patients (aged 1 day–18 years) who had at least two serum creatinine levels determined during the same hospital admission. AKI was defined and staged according to Kidney Disease Improving Global Outcomes (KDIGO) guidelines (and 2021 Consensus conference). AKI awareness was considered the recognition of AKI diagnosis during admission as noted in the medical records according to ICD-10 Clinical Modification codes (N17.0, N17.1, N17.2, N17.8, N19, N99.0 and P96.0). AKI non-awareness was considered in patients presenting AKI criteria without diagnoses recognition in the medical records. We considered baseline serum creatinine the lowest serum creatinine value in 7 days from admission.

RESULTS
Over the 7-year period, 1867 patients developed AKI out of 127 457 hospital admissions. The overall AKI incidence was 1.46% and the annual incidence increased 3.95-fold during the 7 years (from 0.6% in the first year to 2.37% in the seventh). Staging AKI according to Acute Kidney Injury Network (AKIN), stage 1 was identified by us in 23.2% of the AKI cases, stage 2 in 31.3% and stage 3 in 45.5%. AKI awareness (as defined above) was 27.5% (overall), being significantly increased in premature babies (P &lt; .012), full-term neonates (P &lt; .0001) and toddlers (P &lt; .0001). In AKI stages 1 and 2 the diagnosis of AKI (included in the patient's documents according to ICD 10) was less frequent as compared to stage 3. So, we considered that AKI awareness is significantly lower in early AKI stages (1 and 2) (i.e.16.9 and 19.7% respectively) as compared with late AKI (stage 3) 38.3% (P &lt; .001). Only 19 patients (1.01%) required renal replacement therapy (RRT). During the 7-year period, the all-cause mortality in our cohort was 0.32% (410 patients died) being 0.13% in the no AKI patients and 12.8% in the AKI group (57.89% in patients treated with RRT). Odds ratio (OR) of death in the AKI diagnosed patients (aware and non-aware) was 107.67 versus non-AKI patients (P &lt; .0001). The risk of death in the AKI aware group was 3.3 higher versus AKI non-aware group (P &lt; .001). These not expected, reverse results, are attributable to a very low awareness (as defined by us in Methods) in the early stages of AKI. A higher mortality rate was associated with AKIN stage 3—OR of 1.53 (P &lt; .001). The average length of hospital stay was significantly higher in AKI patients (20.79 days) as compared with the no AKI group (5.74 days).

CONCLUSION
The awareness of AKI in children remains a problem worldwide with implications on the survival of patients. Being aware of AKI means early identifying the risk of AKI, early diagnosis and early intervention. As it was presented above late diagnosis and awareness are associated with high mortality rate and the need for interventions (RRT) associated with high mortality risk.