ESPN 54th Annual Meeting

ESPN 2022


 
IS THER ANY ROLE OF THE URINE DICKOPPF-3/CREATININE RATIO IN EARLY DETECTION OF ACUTE KIDNEY INJURY IN PEDIATRIC INTENSIVE CARE UNIT?
Sefa Armağan Gökçeli 1 Neslihan Gunay 1 Inayet Güntürk 2 Mehmet Akif Dündar 3 Başak Nur Akyıldız 3 Cevat Yazıcı 4 Sibel Yel 1 M.Hakan Poyrazoğlu 1 Ismail Dursun 1

1- Erciyes University Faculty of Medicine, Department of Pediatrics, Division of Nephrology, KAYSERİ, TURKIYE
2- Department of Midwifery, School of Health, Niğde Omer Halisdemir University
3- Erciyes University Faculty of Medicine, Department of Pediatrics, Division of Intensive Care
4- Erciyes University Faculty of Medicine, Department of Biochemistry
 
Introduction:

Acute kidney injury (AKI) is a common complication in the pediatric intensive care unit (PICU) and there are many studies on new biomarkers to predict AKI earlier than serum creatinine (SCr). Recently, few studies have focused on urinary DKK-3, which may be an early biomarker of AKI. In this study, we investigate the role of urinary DDK-3 in early prediction of AKI in patients hospitalized in PICUAcute kidney injury (AKI) is a common complication in the pediatric intensive care unit (PICU) and there are many studies on new biomarkers to predict AKI earlier than serum creatinine (SCr). Recently, few studies have focused on urinary DKK-3, which may be an early biomarker of AKI. In this study, we investigate the role of urinary DDK-3 in early prediction of AKI in patients hospitalized in PICU

Material and methods:

In this prospective study, between June 2020 and April 2021, 117 patients who stayed in PICU for at least 48 hours were included. On admission, PRISM, PELOD, “Vasoactive inotrope Score” of patients using vasopressors were also noted. We measured urine DKK-3, creatinine, micro protein, serum creatinine and calculated micro protein to creatinine ratio (PCR), eGFR and urine DKK3/cre ratio. From admission to 10th day of hospitalization or death, patients were followed-up with serum creatinine. AKI was defined based on KDIGO 2012 criteria. The impact of the urine DKK3/Cr on the development of AKI and mortality, and its sensitivity and specificity was investigated.

Results:

AKI developed in 42 of the patients. The most common reasons were malignancy and cardiac disease for AKI.  Respiratory failure and postoperative cardiac surgery were the most common reasons for hospitalization in PICU. Urine DKK3/cre ratio was found to be higher in patients who developed AKI compared to those who did not develop KDIGO SCr. Urine DKK3/cre ratio was found to be higher in patients with stage 3 AKI than those with stage 1 and stage 2 AKI. The power of urinary DKK3/crea ratio to predict the development of AKI in patients hospitalized in the pediatric intensive care unit was 73.2% by AUROC analysis. The urine DKK3/cre cut-off value for the detection of AKI was 63311 pg/mg, the sensitivity was 23.8% and the specificity was 94.6%. AKI was observed more frequently in patients with nephrotic proteinuria on the first day of hospitalization in the pediatric intensive care unit compared to those without. Urine DKK3 was found to be a risk factor both AKI and mortality in univariate and multivariate logistic regression analysis (Table 1,2). The DKK3 value above the cut-off point increases the risk of developing AKI by 5.547 times and mortality by 5.569 times (Table3,4).

Conclusions:

Urine DKK3/cre ratio is a clinically useful biomarker in predicting the development of AKI according to KDIGO SCr in patients hospitalized in PICU. In patients with nephrotic level proteinuria in spot urine, AKI develops more frequently and the urinary DKK3/cre ratio is found to be higher. A high level of urine DKK3 is a risk factor for both AKI and mortality in children in PICU.