Correction to: Short-term outcome associated with disease severity and electrolyte abnormalities among critically ill children with acute kidney injury.

Following publication of the original article [1].

Short-term outcome associated with disease severity and electrolyte abnormalities among critically ill children with acute kidney injury.

BACKGROUND: Acute kidney injury (AKI) in critically ill children is associated with increased mortality and morbidity. In this study we evaluated the effect of AKI severity on the incidence of short-term mortality and morbidity. METHODS: Multicenter prospective cohort study was conducted over two years period. We used the Kidney Disease Improving Global Outcomes (KDIGO) to diagnose and stage AKI. RESULTS: A total of 511 out of 1367 included children (37.4%; 95% CI: 34.8-40.0) were diagnosed with AKI. They were categorized into three KDIGO stages: stage I (mild) in 47.5% (95% CI: 43.2-52.0), stage II (moderate) in 32.8% (95% CI: 28.8-37.1) and stage III (severe) in 19.7% (95% CI: 16.4-23.5). Stage II and III AKI had higher risk of mortality and longer length of stay (LOS) in hospital. Children with stage III AKI were more likely to require mechanical ventilation, referral to pediatric nephrology and discharge with abnormal creatinine level (above 100 uml\L). Hypervolemia, hypocalcemia, anemia, and acidosis were found to be independent risk factors of mortality. CONCLUSION: The extent of severity of AKI is directly associated with increased mortality, LOS and short-term morbidity.

Outcome of pediatric acute kidney injury: a multicenter prospective cohort study.

BACKGROUND: Acute kidney injury (AKI) is a common problem encountered in critically ill children with an increasing incidence and evolving epidemiology. AKI carries a serious morbidity and mortality in patients requiring admission to a pediatric intensive care unit (PICU). METHODS: We undertook a prospective cohort study of PICU admissions at three tertiary care hospitals in the Kingdom of Saudi Arabia over 2 years. The Kidney Disease Improving Global Outcomes (KDIGO) definition was used to diagnose AKI. RESULTS: A total of 1367 pediatrics PICU admissions were included in the study. AKI affected 511 children (37.4%), with 243 children (17.8%) classified as stage I (mild), 168 patients (12.3%) stage II (moderate), and 100 children (7.3%) were classified as stage III (severe). After adjustment for age, sex, and underlying diagnosis, in-hospital mortality was six times more likely among patients with AKI as compared to patients with normal renal function (adjusted OR: 6.5, 95% CI: 4.2-10). AKI was also a risk factor for hypertension (adjusted OR: 4.1, 95% CI: 2.8-5.9) and prolonged stay in the PICU and hospital, as it increased the average number of admission days by 10 (95% CI: 8.6-11) days in the PICU and 12 (95% CI: 10-14) days in the hospital. CONCLUSIONS: One-third of PICU admissions were complicated with AKI. AKI was associated with increased hospital mortality and the length of stay in both PICU and hospital.

Serum cystatin is a useful marker for the diagnosis of acute kidney injury in critically ill children: prospective cohort study.

BACKGROUND: Acute kidney injury (AKI) has been associated with high morbidity and mortality rates among critically ill children. Cystatin C is a protease inhibitor, and studies have shown that it is a promising marker for the early diagnosis of AKI. Our goal in this study was to assess whether serum cystatin C could serve as an accurate marker for the diagnosis of AKI. METHODS: This prospective study was undertaken in the pediatric intensive care unit at King Abdulaziz University Hospital. Serum creatinine and serum cystatin C levels were both measured in patients on admission (0 h) and at 6, 12, and 24 h after admission. AKI was diagnosed according to the modified pRIFLE criteria. Receiver operating characteristic (ROC) curve analysis was performed to assess the utility of serum cystatin C for diagnosing AKI. RESULTS: A total of 62 patients were enrolled in this study, and 32 were diagnosed with AKI according to the modified pRIFLE criteria (51.4 %). The area under the ROC curve for serum cystatin indicated that it was a good marker for the diagnosis of AKI at 0, 6, 12 and 24 h, with sensitivities of 78, 94, 94 and 83 %, respectively. However, the specificities of serum cystatin C at 0, 6, 12, and 24 h were 57, 57, 60 and 50 %, respectively. The optimal cutoff value was 0.645 mg/L. The area under the ROC for serum creatinine showed sensitivities of 50, 65.4, 69.2 and 57.7 % and specificities of 67.7, 70, 60 and 70 % at 0, 6, 12 and 24 h, respectively. The optimal cutoff value for serum creatinine was 30 µmol/l. Comparisons of ROC curves revealed that serum cystatin C was superior to serum creatinine for the diagnosis of AKI at 12 h (p = 0.03), but no differences were detected at 0, 6 or 24 h. CONCLUSION: Serum cystatin is a sensitive, but not a specific, marker for the diagnosis of AKI in critically ill children.

Outcome of acute kidney injury in pediatric patients admitted to the intensive care unit.

BACKGROUND: Acute kidney injury (AKI) is common in the pediatric intensive care unit (PICU). We aimed to describe the etiology, clinical features, and outcome of AKI in pediatric patients and to determine the predictors for initiation of renal replacement and mortality. METHODS: A retrospective chart review was performed of the medical records for all patients who were admitted to the PICU at King Abdulaziz University Hospital between January 1 and December 31, 2011. The pediatric-modified RIFLE criteria were used to classify AKI. RESULTS: We included 102 children with AKI, aged 4 - 60 months. Oliguria (61.5%, p < 0.0001) and hypervolemic signs (38.5%, p = 0.03) were more common among patients with RIFLE class failure. They also had the highest mortality (53.9%, p = 0.01). Oliguric patients were ~ 23 times more likely than their non-oliguric counterparts to be initiated on renal replacement therapy (RRT) (RR = 23.38, 95% CI: 3.07 - 178.16). Diuretic infusion was also a strong predictor for RRT initiation (RR = 10.00, 95% CI: 2.77 - 36.12). Hypervolemic patients were twice more likely to die during hospitalization in both unadjusted and adjusted models (RR = 2.06, 95% CI: 1.09 - 3.90, and aRR = 2.45, 95% CI: 1.09 - 5.51, respectively). Mechanical ventilation and RRT initiation were associated with higher likelihood of death (ARR = 13.23, 95% CI: 1.90 - 92.04, and ARR = 2.20, 95% CI: 1.18 - 4.12, respectively). Patients with RIFLE class Failure were about thrice more likely than patients with RIFLE class Risk to die in both the unadjusted (RR = 2.76, 95% CI: 1.35 - 5.65), and adjusted models (ARR = 2.88, 95% CI: 1.38 - 6.04). Children with AKI had longer PICU stay (0.0003) and higher mortality (< 0.0001) than the non-AKI group. CONCLUSION: Severe AKI predicted high mortality in critically ill children.

Dominance of the ON1 Genotype of RSV-A and BA9 Genotype of RSV-B in Respiratory Cases from Jeddah, Saudi Arabia.

Human respiratory syncytial virus (HRSV) is a main cause of hospital admission for lower respiratory tract infection. In previous studies from Saudi Arabia, higher prevalence of the NA1 genotype in group A was observed from Riyadh and Taif. This study recruited respiratory cases from Jeddah during January to December, 2017. RSV represented 13.4% in the recruited cases with 64% of them belonging to group A and 36% to group B. All group A cases in this study were ON1 type characterized by duplication of 72 nucleotides, 24 amino acids in the C-terminal in the second hypervariable region of the G gene. In addition, for group B all of the cases were clustered under BA9, which had uniquely characterized as duplication of 60 nucleotides in the G protein. Our sequences showed similarity with earlier sequences from Saudi Arabia, Kuwait, Thailand, South Africa, Spain, the USA and Cyprus. Some amino acid substitutions in the investigated sequences would cause a change in potential O-glycosylation and N-glycosylation profiles from prototype ON1. The predominance of the ON1 and BA9 genotype of RSV-A in Jeddah compared to previous Saudi studies showing predominance of the NA1 genotype for group A. This difference in genotype prevalence could be due to fast spread of the ON1 genotype worldwide or due to the flux of travelers through Jeddah during hajj/umrah compared to Riyadh and Taif. This shift in genotype distribution requires continuous surveillance for genetic characterization of circulating respiratory infections including RSV. These findings may contribute to the understanding of RSV evolution and to the potential development of a vaccine against RSV.

An audit of in-hospital cardiopulmonary resuscitation in a teaching hospital in Saudi Arabia: A retrospective study.

OBJECTIVES: Data reflecting cardiopulmonary resuscitation (CPR) efforts in Saudi Arabia are limited. In this study, we analyzed the characteristics, and estimated the outcome, of in-hospital CPR in a teaching hospital in Saudi Arabia over 4 years. METHODS: A retrospective, observational study was conducted between January 2009 and December 2012 and included 4361 patients with sudden cardiopulmonary arrest. Resuscitation forms were reviewed. Demographic data, resuscitation characteristics, and survival outcomes were recorded. RESULTS: The mean ± standard deviation age of arrested patient was 40 ± 31 years. The immediate survival rate was 64%, 43% at 24 h, and 30% at discharge. The death rate was 70%. Respiratory type of arrest, time and place of arrest, short duration of arrest, witnessed arrest, the use of epinephrine and atropine boluses, and shockable arrhythmias were associated with higher 24-h survival rates. A low survival rate was found among patients with cardiac types of arrest, and those with a longer duration of arrest, pulseless electrical activity, and asystole. Comorbidities were present in 3786 patients with cardiac arrest and contributed to a poor survival rate (P < 0.001). CONCLUSIONS: The study confirms the findings of previously published studies in highly developed countries and provides some reflection on the practice of resuscitation in Saudi Arabia.

Impact of acute kidney injury on long-term mortality and progression to chronic kidney disease among critically ill children.

OBJECTIVES: To determine the 2-year outcome of acute kidney injury (AKI) following admission to pediatric critical care units (PICU). Methods: A retrospective cohort study was conducted between January 2012 and December 2013. We followed 131 children admitted to PICU, King Abdulaziz University Hospital, Jeddah, Kingdom of Saudi Arabia with a diagnosis of AKI, based on pRIFLE (pediatric risk, injury, failure, loss, and end-stage renal disease), for 2 years. During the study period, 46 children died and 38 of survivors completed the follow-up. Factors affecting long-term progression to chronic kidney disease were also evaluated. Results: The 2-year mortality was more than 40%. The main determinant of the 2-year mortality was the pediatric risk of mortality (PRISM) score, which increased the risk of mortality by 6% per each one score (adjusted odds ratio, 1.06: 95% confidence interval: 1.00-1.11). By the end of the 2 years, 33% of survivors had reduction in the glomerular filtration rate and proteinuria, and 73% were hypertensive. Patients with more severe renal impairment at admission, based on the pRIFLE criteria, had higher mortality rate. This association, however, was not independent since it was influenced by baseline disease severity (PRISM score).  Conclusion: Large proportion of patients admitted to PICU with AKI either died during the first 2 months of follow-up or developed long-term complications. The severity of AKI, however, was not an independent risk factor for mortality.

Clinical profile of admitted children with febrile seizures.

OBJECTIVE: The objectives of this study were to evaluate the clinical profile, investigations, treatments and outcome of hospitalized children with febrile seizures. METHODS: A series of 69 consecutive children with febrile seizures was identified by chart review from 1st January 1997 to 1st January 2002 at King Abdul-Aziz University Hospital in Jeddah, Kingdom of Saudi Arabia. Clinical, laboratory, EEG, and neuroimaging data were evaluated by one investigator using a structured data collection form. RESULTS: The children`s ages ranged between 7-70 months (mean 20, SD 14), and 59.5% were males. The source of the febrile illness was evident in 65%, however, most admitted children (60 out of 69) had atypical seizures (55%), were ill looking (24.5%), had febrile status (17.5%), or positive meningeal irritation signs (4%). Electrolyte abnormalities were uncommon (10%), however, complete blood count was abnormal in 45%, which increased the likelihood of receiving intravenous antibiotics (p=0.01). Lumbar puncture was performed on 75%, particularly those with a first seizure (odds ratio [OR] 3.8, 95% confidence interval [CI] 0.9-15) or younger than 2 years of age (OR 3.4, 95% CI 0.7-17). Brain CT was performed in 13% and EEG in 33%. Obtaining an EEG was less likely if the seizures were typical (13% versus 50% in atypical, p=0.002). Duration of hospitalization ranged between 1-14 days (mean 4.7, SD 3.2), and only one child had meningitis, which was predicted clinically. CONCLUSION: Pediatricians are selective in admitting and investigating children with febrile seizures. The children frequently had atypical seizures, status epilepticus, or were ill looking. The yield of investigations remains low and does not justify extensive work-up or prolonged hospitalization.