The Risk Factors Of Septic Acute Kidney Injury In PICU Critical Ill Children And The Role Of Serum Cystatin C In Early Diagnosis Of AKI

Background and Objectives: A key treatment of AKI is early identification andearly intervention,Studies have shown that sepsis is a risk factor of AKI.But few studiesreported the risk factors of septic acute kidney injury occurred in PICU critical ill children.Studies have reported that the value of cystatin C in its early diagnosis,but It was notwidespread using in clinical.We conducted this study to evaluate the incidence of septicacute kidney injury in PICU, analysis its risk factors of occurrence and the early diagnosisvalue of serum cystatin C.Methods: A prospective cohort study, performed in Children’s Hospital of HunanProvince intensive care units between October2012to September2013. The children whowere diagnosed of sepsis was observed in the study and who had other risk factors such aschronic kidney disease or received kidney transplants and so on,rather than sepsis,thatwould lead to AKI were excluded from the study. All the children were given the PCISscores within24h after admission, In accordance with the contemplated the clinicalregistration form to collect information. the observation time from the day the children onadmission PICU until discharged Day or day of death. The serum cystatin C, serum β2-microglobulin, serum creatinine, blood urea nitrogen etc were collected On the day ofadmission, the third day, the fifth day after admission. The children included in the studywere divided into two groups: sepsis with septic AKI and sepsis without AKI groupaccording to AKI diagnostic criteria. Dynamic observation data to fill in the registrationform.Results:1.The incidence of septic AKI in PICU children was35.20%, AKI in severe sepsis, septicshock incidence was47.22%and76.92%respectively. Different stages of renal injury had different PCIS score, P=0.000.The mortality rate of children with septic AKI and withoutAKI were31.88%and8.66%.The presense of Myocardial damage or septic shock andhigher cystatin C levels were risk factors of the incidence of septic acute kidney injury,the OR values were2.640(95%CI1.1246.200)、7.408(95%CI1.45837.637)、26.218(95%CI6.235110.232)。2.The area under the ROC curve of after admission blood urea nitrogen, β2-microglobulin,cystatin C diagnosis of AKI were0.718,0.537,0.831,We identified a cutoff point of1.325mg/L for the admission cystatin C value for the diagnosis of septic AKI with asensitivity of87.1%and specificity of78.9%. In the AKI group, The admission cystatin Cvalue and the third day of creatinine value were significantly positive correlation, rs=0.582, P=0.000.Conclusions:1. The incidence of septic AKI was increased significantly with the severity of sepsis,Thechildren with myocardial damage or septic shock and higher Cys C levels were risk factorsfor the onset of AKI.2. Compare to creatinine,cystatin C was earlier increased in children with septic AKI andcorrelated with it, it can be take as a biomarker for early diagnosis of septic AKI in PICUcritical ill children.