CRIB, CRIB II, SNAP, SNAP II AND SNAP-PE SCORING SYSTEMS AND RIFLE CRITERIA IN CRITICALLY ILL NEONATES WITH ACUTE RENAL FAILURE

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MOHKAM M.; AFJEII A.; FAKHRAII H.; KAZEMIAN M.

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Journal: Iranian Journal of Kidney Diseases Year:2011 | Volume:5 | Issue:SUPPLEMENT 2 Page(s): 19-20

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Title

CRIB, CRIB II, SNAP, SNAP II AND SNAP-PE SCORING SYSTEMS AND RIFLE CRITERIA IN CRITICALLY ILL NEONATES WITH ACUTE RENAL FAILURE

Author(s)

MOHKAM M. | AFJEII A. | FAKHRAII H. | KAZEMIAN M.

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Abstract

Introduction: More than 30 Acute Kidney Injury (AKI) definitions exist in the published literature and there is no consensus especially in neonatal group. Chevalier and colleagues defined neonatal acute renal failure as serum creatinine values>1.5 mg/dL for at least 24 hours. Acute Renal Failure (ARF) affects approximately 1% to 24% of newborns in the Neonatal Intensive Care Units (NICUs). ARF is a significant factor of morbidity and mortality in critically ill children. The Acute Dialysis Quality Initiative (ADQI) group has recently proposed the RIFLE criteria for AKI in adults. The RIFLE acronym stands for risk, injury, failure, loss of kidney function and end-stage renal disease. This classification system to define AKI in neonatal group has not been performed. We hypothesized that critically ill neonates with ARF based on old definition (serum creatinine more than 1.5 mg/ dL) have decreased survival, independent of demographic characteristics, co-morbidities, clinical parameters, severity of illness and interventions variables known to predict infant survival.According to this hypothesis, we evaluated urine output, serum creatinine, and glomerular filtration rate in critically ill neonates and compared them to RIFLE scoring system.Methods: This cohort study was conducted at the neonatal intensive care units of Mofid and Mahdieh hospitals which are two of the largest referral neonatal hospitals in Tehran. There are about 4400 deliveries annually in the Mahdieh hospital and about 2000 admissions to the both neonatal intensive care units each year. Between March 2006 and May 2009 all neonates transferred to these NICUs were enrolled for the study in a prospective manner. We determined GFR, urine output, mortality, morbidity, and the RIFLE scorefor each neonate. We also evaluated CRIB, CRIB II, SNAP, SNAPII and SNAP-PE score for each neonate and the final scores were then obtained by the arithmetic sum of individual scores of these parameters. The predictive accuracy of these receivers were expressed as area under the receiver operative characteristic (ROC) curve for each score and help to compare the performance of different tests, by plotting sensitivity, specificity, PPV and NPV. All groups were statistically analyzed by the t test and logistic model was used to analyze the prediction of mortality. The ethics committee of the Shahid Beheshti medical university and pediatric infectious research center approved this study.Results: We evaluated 404 neonates of NICUs of Mofid and Mahdieh hospitals during 2007 to 2009. Based upon RIFLE scoring system, 22.5% (91 neonates) of our study group had normal renal function and 77.5% (313 neonates) of them had abnormal renal function at the second day of admission. Therefore 313 neonates (77.5%) developed AKI by RIFLE criteria and among them 43% (135 neonates) met the risk, 51% (161 neonates) the injury and about 6% (17 neonates) the failure criterion. Based on old definition of ARF in neonates the rate of ARF in our study group was 3.2% (13 out of 404 neonates had serum creatinine more than 1.5 mg/dL), P<.001. In this study, we detected an overall in-hospital mortality of 20.5% in critically ill neonates. Of those who died, 81.9% (68 of 83 patients) had AKI. In patients with normal renal function, the rate of mortality was 16.5% and in patients with AKI based on RIFLE scoring system the mortality rate was 21.7% (P<.31). In R (risk) group the mortality rate was 16.3%, in I (injury) group the mortality rate was 24.2% and in F (failure) group the mortality rate was 41.2%.In patients with ARF based on creatinine level definition (serum creatinine more than 1.5 mg/dL) the mortality rate was 61.5% (P<.001, OR=6.741).A progressive and significant elevation in mortality was correlated with increasing RIFLE classification severity among all patients. (OR=1.406, P=.042, CI=0.76 to 2.06). The patients who had any degree of AKI at the time of admission to the NICU as well as those who had normal renal function had statistically significant higher median CRIB, CRIB II, SNAP, SNAP II and SNAP-PE NICU scoring systems, lower levels of apgar score, serum PH, serum bicarbonate and platelet count and wereyounger and smaller. Injury group on admission was associated with higher mortality than Risk group on admission (P<.001) and patients who developed Failure criteria during NICU stay had higher mortality than those who developed Risk group criteria (OR=3.17) or Injury group (OR=1.84).Conclusions: We concluded that a RIFLE criterion is a practical method to define AKI in neonatal group and it will be a good predictive tool for morbidity and mortality in NICUs.

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APA: Copy

MOHKAM, M., AFJEII, A., FAKHRAII, H., & KAZEMIAN, M.. (2011). CRIB, CRIB II, SNAP, SNAP II AND SNAP-PE SCORING SYSTEMS AND RIFLE CRITERIA IN CRITICALLY ILL NEONATES WITH ACUTE RENAL FAILURE. IRANIAN JOURNAL OF KIDNEY DISEASES (IJKD), 5(SUPPLEMENT 2), 19-20. SID. https://sid.ir/paper/309235/en

Vancouver: Copy

MOHKAM M., AFJEII A., FAKHRAII H., KAZEMIAN M.. CRIB, CRIB II, SNAP, SNAP II AND SNAP-PE SCORING SYSTEMS AND RIFLE CRITERIA IN CRITICALLY ILL NEONATES WITH ACUTE RENAL FAILURE. IRANIAN JOURNAL OF KIDNEY DISEASES (IJKD)[Internet]. 2011;5(SUPPLEMENT 2):19-20. Available from: https://sid.ir/paper/309235/en

IEEE: Copy

M. MOHKAM, A. AFJEII, H. FAKHRAII, and M. KAZEMIAN, “CRIB, CRIB II, SNAP, SNAP II AND SNAP-PE SCORING SYSTEMS AND RIFLE CRITERIA IN CRITICALLY ILL NEONATES WITH ACUTE RENAL FAILURE,” IRANIAN JOURNAL OF KIDNEY DISEASES (IJKD), vol. 5, no. SUPPLEMENT 2, pp. 19–20, 2011, [Online]. Available: https://sid.ir/paper/309235/en

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