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Identifier 000454674
Title Ο δείκτης Renal Angina Index ως προβλεπτικός παράγοντας υπερφόρτωσης υγρών η οξείας νεφρικής βλάβης σε παιδιατρικούς ασθενείς ΜΕΘ / Θάλεια Καραβέργου.
Alternative Title Renal Angina Index as a predictor of fluid overload or acute renal injury in critically ill children
Author Καραβέργου, Θάλεια
Thesis advisor Ηλία, Σταυρούλα
Reviewer Μπριασούλης, Γεώργιος
Βαπορίδη, Κατερίνα
Abstract Background: Acute kidney injury (AKI) occurs commonly in critically ill children hospitalized in Pediatric Intensive Care Units (PICU). AKI is associated with poor short-term and long-term outcomes such as increased duration of mechanical ventilation, prolonged hospitalization, proteinuria, increased risk of chronic kidney disease and death. Recently, fluid overload (FΟ) was associated with AKI and poor prognosis. AKI and FO share a bidirectional risk. AKI is a risk factor for FO and fluid accumulation is a risk factor for AKI. When these two phenomena act simultaneously, patients face greater risk of poor outcomes. Management of AKI is based on supportive care since there is no efficient therapeutic intervention. Early recognition of AKI and identification of patients at risk of AKI led to the idea of “renal angina” (RA) and the introduction of “Renal Angina Index” (RAI) as a validated measurement of RA that combines patient-specific risk factors as well as early signs of renal dysfunction. RAI is scored at hospital admission and is evaluated on its capacity to predict AKI 3 days after admission. Lacking sufficient tools for detecting FO, RAI is also investigated as a predictor of FO. Objective: The purpose of this study is to evaluate RAI as a predictor of acute kidney injury and fluid overload in critically ill children. Simultaneously it is of great importance to compare RAI’s performance with traditional RAI markers and investigate the relation of RAI with risk factors and clinical signs of AKI, markers of illness severity and markers of outcome. Methods: This study was conducted in the University Hospital of Heraklion PICU. Data were collected retrospectively from medical records of patients admitted between January 2018 and November 2022. Data collection form contained demographic and clinical information, illness- severity indices, markers of outcome, presence or absense of AKI (KDIGO), fluid accumulation (FO) and therapeutic interventions. Results: A total of 200 critically ill children were included, with a mean age of 4,7 years. The vast majority (63,5%) were males, 63% (n=126) were mechanicaly ventilated, 23% (n=46) had comorbidities and total AKI incidence was 19,5% (n=39). Crude mortality was estimated at 8% (n=16) and associated with older age (p=0.039), comorbidities (p=0.013), higher PIM-III score (p=0.001), longer duration of PICU and in-hospital stay (p=0.001) and longer duration of mechanical ventilation (p<0.006). RAI (+)>8 was independently associated with the duration of mechanical ventilation (p=0.012), AKI (p=0.034, p=0.001) and FO development (p=0.002) 3 days after PICU admission. Also, the positive index was related with Multiple Organ Dysfunction Syndrome (MODS), use of diuretics, vasoactive support, longer duration of PICU and in-hospital stay and higher mortality (all, p<0.001). RAI appeared to be non-inferior at prediction of AKI (all stage and severe) compared to traditional AKI markers, however did not manage to predict FO 3 days after PICU admission. Conclusion: Positive RAI was independentely associated with the imminent AKI and FO in PICU patients. Its ability on AKI prediction was found to be decent and equal to traditional AKI biomarkers although it didn’t manage to predict FO. RAI (+) was associated with risk factors of AKI (mechanical ventilation, inotropes), markers of illness severity (PIM III score), multiple organ dysfunction syndrome (MODS), FO and markers of outcome such as PICU length of stay and in-hospital stay. RAI is a valuable and costless index of AKI and FO development in patients hospitalized in a PICU. Further studies are needed in critically ill or traumatized children to evaluate RAI’s application in clinical everyday practice and its effect on children’s outcome.
Language Greek
Subject Acute kidney injury
Δείκτης νεφρικής ισχαιμίας
Θετικό ισοζύγιο υγρών
Issue date 2023.
Collection   School/Department--School of Medicine--Department of Medicine--Post-graduate theses
  Type of Work--Post-graduate theses
Permanent Link https://elocus.lib.uoc.gr//dlib/4/3/8/metadata-dlib-1709881352-166513-22958.tkl Bookmark and Share
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