TY - JOUR
T1 - Optimizing the AKI definition during first postnatal week using Assessment of Worldwide Acute Kidney Injury Epidemiology in Neonates (AWAKEN) cohort
AU - for the Neonatal Kidney Collaborative
AU - Askenazi, David
AU - Abitbol, Carolyn
AU - Boohaker, Louis
AU - Griffin, Russell
AU - Raina, Rupesh
AU - Dower, Joshua
AU - Davis, T. Keefe
AU - Ray, Patricio E.
AU - Perazzo, Sofia
AU - DeFreitas, Marissa
AU - Milner, Lawrence
AU - Ambalavanan, Namasivayam
AU - Cole, F. Sessions
AU - Rademacher, Erin
AU - Zappitelli, Michael
AU - Mhanna, Maroun
AU - Selewski, David T.
AU - Sarkar, Subrata
AU - Kent, Alison
AU - Fletcher, Jeffery
AU - Duara, Shahnaz
AU - Charlton, Jennifer R.
AU - Swanson, Jonathan R.
AU - Guillet, Ronnie
AU - D’Angio, Carl
AU - Mian, Ayesa
AU - Kumar, Deepak
AU - Jetton, Jennifer G.
AU - Brophy, Patrick D.
AU - Colaizy, Tarah T.
AU - Klein, Jonathan M.
AU - Arikan, Ayse Akcan
AU - Rhee, Christopher J.
AU - Goldstein, Stuart L.
AU - Nathan, Amy T.
AU - Kupferman, Juan C.
AU - Bhutada, Alok
AU - Rastogi, Shantanu
AU - Bonachea, Elizabeth
AU - Mahan, John
AU - Smith, Alexandra
AU - Fuloria, Mamta
AU - Reidy, Kimberly
AU - Kaskel, Frederick J.
AU - Soranno, Danielle E.
AU - Gien, Jason
AU - Gist, Katja M.
AU - Chishti, Aftab S.
AU - Hanna, Mina H.
AU - Hingorani, Sangeeta
N1 - Publisher Copyright:
© 2019, International Pediatric Research Foundation, Inc.
PY - 2019/2/1
Y1 - 2019/2/1
N2 - Background: Neonates with serum creatinine (SCr) rise ≥0.3 mg/dL and/or ≥50% SCr rise are more likely to die, even when controlling for confounders. These thresholds have not been tested in newborns. We hypothesized that different gestational age (GA) groups require different SCr thresholds. Methods: Neonates in Assessment of Worldwide Acute Kidney Epidemiology in Neonates (AWAKEN) with ≥1 SCr on postnatal days 1–2 and ≥1 SCr on postnatal days 3–8 were assessed. We compared the mortality predictability of SCr absolute (≥0.3 mg/dL) vs percent (≥50%) rise. Next, we determine usefulness of combining absolute with percent rise. Finally, we determined the optimal absolute, percent, and maximum SCr thresholds that provide the highest mortality area under curve (AUC) and specificity for different GA groups. Results: The ≥0.3 mg/dL rise outperformed ≥50% SCr rise. Addition of percent rise did not improve mortality predictability. The optimal SCr thresholds to predict AUC and specificity were ≥0.3 and ≥0.6 mg/dL for ≤29 weeks GA, and ≥0.1 and ≥0.3 mg/dL for >29 week GA. The maximum SCr value provides great specificity. Conclusion: Unique SCr rise cutoffs for different GA improves outcome prediction. Percent SCr rise does not add value to the neonatal AKI definition.
AB - Background: Neonates with serum creatinine (SCr) rise ≥0.3 mg/dL and/or ≥50% SCr rise are more likely to die, even when controlling for confounders. These thresholds have not been tested in newborns. We hypothesized that different gestational age (GA) groups require different SCr thresholds. Methods: Neonates in Assessment of Worldwide Acute Kidney Epidemiology in Neonates (AWAKEN) with ≥1 SCr on postnatal days 1–2 and ≥1 SCr on postnatal days 3–8 were assessed. We compared the mortality predictability of SCr absolute (≥0.3 mg/dL) vs percent (≥50%) rise. Next, we determine usefulness of combining absolute with percent rise. Finally, we determined the optimal absolute, percent, and maximum SCr thresholds that provide the highest mortality area under curve (AUC) and specificity for different GA groups. Results: The ≥0.3 mg/dL rise outperformed ≥50% SCr rise. Addition of percent rise did not improve mortality predictability. The optimal SCr thresholds to predict AUC and specificity were ≥0.3 and ≥0.6 mg/dL for ≤29 weeks GA, and ≥0.1 and ≥0.3 mg/dL for >29 week GA. The maximum SCr value provides great specificity. Conclusion: Unique SCr rise cutoffs for different GA improves outcome prediction. Percent SCr rise does not add value to the neonatal AKI definition.
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U2 - 10.1038/s41390-018-0249-8
DO - 10.1038/s41390-018-0249-8
M3 - Article
C2 - 30643188
AN - SCOPUS:85059950208
SN - 0031-3998
VL - 85
SP - 329
EP - 338
JO - Pediatric Research
JF - Pediatric Research
IS - 3
ER -