Dados do Trabalho

Título

Point-of-care ultrasound to predict acute kidney injury in children undergoing cardiac surgery: Accuracy of renal arterial Doppler-based variables

Objetivo

Acute kidney injury (AKI) is a common condition in critically ill children and is associated with increased morbidity and mortality. This study aims to assess the accuracy of point-of-care ultrasonography to predict AKI in children undergoing cardiac surgery.

Métodos

Consecutive children aged <14 years underwent renal Doppler ultrasound examination within 24 hours of cardiac surgery. Renal resistive index (RRI) and renal pulsatility index (RPI) were measured. AKI was defined by the Kidney Disease Improving Global Outcome (KDIGO) criteria. The primary outcome was severe AKI (KDIGO stage 2 or 3) on day 3.

Resultados

A total of 58 patients were included. Median age and weight were 12.9 months (IQR 6.0 – 37.9) and 7.36 kg (IQR 5.19 – 11.40), respectively. On day 3, 12 patients were classified as having AKI, of which 11 were severe. RRI could effectively predict AKI (area under the ROC curve [AUC] 0.83, 95%CI 0.71-0.92; p<0.001) as well as RPI (AUC 0.81, 95%CI 0.69-0.90; p<0.001). The optimal cut-off value for RRI was 0.85 (sensitivity, 73%; specificity, 83%; positive predictive value [PPV], 50%; and negative predictive value [NPV], 93%), while for RPI was 1.95 (sensitivity, 73%; specificity, 78%; PPV, 44%; and NPV, 92%). Similar results were found in the analysis for prediction on day 5. Significant correlations were found between Doppler-based variables and estimated GFR at enrollment and on day 3. Also, both variables significantly correlated with diuretic scores on day 3.

Conclusão

Renal Doppler ultrasound may be a promising tool for predicting AKI in children undergoing cardiac surgery.