Prediction of early diagnosis of acute kidney injury in premature infants with hemodynamically significant patent ductus arteriosus

Abstract

The development of acute kidney injury (AKI) in preterm infants with hemodynamically significant patent ductus arteriosus (HSPDA) is an additional burden on homeostatic mechanisms, leading to loss of fluid, electrolyte balance, and acid-base disturbance and increasing the risk of mortality by 50%. Therefore, early detection of AKI in preterm infants with HSPDA is extremely important in terms of improving treatment outcomes.

Purpose — to create, evaluate and further analyze the binary logistic regression model of AKI on the background of HSPDA in premature infants.

Materials and methods. The group of study participants consisted of 40 premature babies with HSPDA, who were admitted for treatment on the first day of life to the Department of Anesthesiology and Neonatal Intensive Care at MI «Dnepropetrovsk Regional Children's Clinical Hospital» Dnepropetrovsk Regional Council». On the third to fifth day of life, 23 (57.5%) patients were diagnosed with AKI. Clinical and laboratory examination included obstetric history, gestational age, weight, physical examination, clinical analysis of blood and urine, arterial blood oxygen saturation, biochemical methods — examination of urea, serum and urine creatinine, serum and urine sodium, serum potassium. The concentration index of creatinine, fractional excretion of sodium, glomerular filtration rate (GFR) according to the Schwartz formula were calculated. Instrumental methods of examination included echocardiography with Doppler, ultrasound Doppler of renal vessels, renal spectroscopy in the near infrared region. In order to preliminarily determine the diagnostic potential of some clinical'anamnestic and laboratory data, the parameters of the sample with AKI and the sample without this pathology were compared: in the case of interval scale the Mann–Whitney U-test was used, in the case of categorical scale — χ²-test or Fisher's exact test. Spearman's rank correlation was used to form the optimal set of input variables for regression modeling. The method of binary logistic regression was used to develop a diagnostic model of AKI development on the background of HSPDA in premature infants.

Results. At the stage of exploratory data analysis (several dozen parameters of clinical and biochemical analysis of blood and urine, renal hemodynamics, renal oxygenation and therapeutic measures on the first day), as well as clinical and anamnestic data, it was found that AKI has a significant relationship with 14 interval ( maximum blood flow velocity in the interlobar renal artery, minimum blood flow velocity in the interlobar renal artery, resistance index in the interlobar renal artery, maximum blood flow velocity in the main renal artery, diameter of the open arterial duct, renal oxygenation, fractional renal tissue extraction of oxygen, serum creatinine, GFR, creatinine concentration index, urinary sodium, fractional sodium excretion, urine protein, diastolic blood pressure) and 9 nominal values (the size of the patent ductus arteriosus on the first day of more than 2 mm, ibuprofen therapy at a dose of 20 mg/kg on the first day, ibuprofen therapy on the first day of life, furosemide treatment, history of renal disease in the mother, chronic foci of infection in the mother, hypertension of pregnancy, threat of abortion, necrotizing enterocolitis in the patient on the first day of life).

Conclusions. The most significant predictors of AKI development in premature infants with HSPDA are the parameter of maximum blood flow velocity in the interlobar renal artery, HSPDA diameter greater than 2 mm and serum creatinine level on the first day of life. The sensitivity of the AKI logistic regression model, in which HSPDA diameter and serum creatinine level are used as explanatory variables, is 91%, specificity — 88%, overall accuracy — 90%. Replacement of serum creatinine in the logit function for the maximum blood flow velocity in the interlobar renal artery allows to increase the sensitivity of the model up to 96%, and the overall accuracy up to 93%.

The study was conducted in accordance with the principles of the Helsinki Declaration. The research protocol was approved by the Local Ethics Committee of the institution mentioned in the work. Informed consent of parents of children was obtained for the research.

The authors were declare no conflict of interest.