Does Microalbuminuria Predict Mortality in Pediatric Intensive Care Unit?

Abstract

The aim of this study is to assess the accuracy of microalbuminuria (MA) to predict the mortality in pediatric intensive care unit (PICU). Between December 2014 and November 2015, 250 patients who were 1 month to 18 years old monitored at least 24 hours in PICU and met study criteria were included. Spot urine samples were measured for microalbuminuria. Pediatric Risk of Mortality III-24 and Pediatric Multiple Organ Dysfunction scores were calculated by using the worst parameters in first 24 hours. The collected data were analyzed with statistical methods and compared with mortality scoring systems and observed mortality. MA values were significantly higher in nonsurvivors than the average of the survivors (18 vs. 48 mg/g, p < 0.05). The receiver operating characteristics curve analysis showed that the areas under the curves for MA was 0.81 at a cut-off value of 32 mg/g, MA measured in 24 hours of admission to PICU may be able to discriminate between patients a with sensitivity of 85.2, specificity of 70.8%, positive predictive value of 31.5%, and negative predictive value of 96.8%. MA is a useful tool to predict mortality in PICU.

Hypophosphataemia definitions, incidence and associated outcomes in paediatric intensive care: A retrospective cohort study in post‐cardiac surgical patients <2 years of age

“…Akbas et al . found PICU patients who were hyperphosphataemic on admission had a significantly higher Paediatric Logistic Organ Dysfunction score and higher mortality 10 . Given that phosphate is well absorbed via the enteral route and minimises the complications arising from IV administration, supplementation by the enteral route has been suggested in children with mild or moderate deficits 23 .…”

“…Our laboratory reference range for serum phosphate was 1.0–2.5 mmol/L for infants aged 0–1 years and 1.0–2.0 mmol/L for children aged 1–2 years. Additional phosphate can be given by enteral supplementation or prescription adjustments for children receiving tailor‐made intravenous (IV) nutrition but phosphate supplementation and hyperphosphataemia also bring risks 10 . Our usual practice therefore was not to initiate phosphate supplementation unless serum phosphate was <0.7 mmol/L.…”

“…Additional phosphate can be given by enteral supplementation or prescription adjustments for children receiving tailor-made intravenous (IV) nutrition but phosphate supplementation and hyperphosphataemia also bring risks. 10 Our usual practice therefore was not to initiate phosphate supplementation unless serum phosphate was <0.7 mmol/L. As our reference range was low in comparison with other reference ranges such as the Australasian Harmonised Reference Intervals for Paediatrics (AHRIP), an increase to the lower limit of the reference range to 1.4 mmol/L for infants and 1.1 for children aged 1-2 years was under consideration.…”

“…Akbas et al found PICU patients who were hyperphosphataemic on admission had a significantly higher Paediatric Logistic Organ Dysfunction score and higher mortality. 10 Given that phosphate is well absorbed via the enteral route and minimises the complications arising from IV administration, supplementation by the enteral route has been suggested in children with mild or moderate deficits. 23 In neonatal intensive care, phosphate supplementation (2 mmol/kg/day) via the enteral route is used in the first few days after birth even in extremely preterm infants who are nil by mouth.…”

Early hypophosphatemia in critically ill children and the effect of parenteral nutrition: A secondary analysis of the PEPaNIC RCT

“…Hence, an occurrence rate of hypophosphatemia in critically ill children varying from 5% to 76% has been reported, depending on the cut-off value used [11]. Moreover, the consequences of hypophosphatemia remain uncertain, although some studies have reported an association between hypophosphatemia and worse clinical outcome in critically ill children [2,5,7,9,10].…”