Identificación precoz de lesión renal aguda en pacientes pediátricos en estado crítico: valor pronóstico de las escalas de pRIFLE, KDIGO y AKIN, en el Hospital del Niño Dr. Francisco De Icaza Bustamante, periodo 2020-2025.

Abstract

Introduction: acute kidney injury is a frequent and severe complication in critically ill pediatric patients. Its early identification remains limited by the coexistence of several diagnostic criteria (pRIFLE, AKIN, and KDIGO), without clear consensus on which offers the greatest clinical utility in the local pediatric population. Objective: to compare the diagnostic and prognostic value of the pRIFLE, KDIGO, and AKIN scales for the early identification of AKI in critically ill pediatric patients admitted to the Pediatric Intensive Care Unit (PICU) and Shock Unit of the Hospital del Niño Dr. Francisco de Icaza Bustamante, during the 2020-2025 period. Methods: an observational, retrospective, longitudinal, and analytical study conducted in 50 pediatric patients aged 1 month to 14 years who met the inclusion criteria. The three diagnostic scales were applied based on serum creatinine and urine output, using KDIGO as the operational reference standard for sensitivity, specificity, predictive values, and ROC curve analysis. The association of each scale with adverse clinical outcomes (renal replacement therapy and mortality) was assessed using odds ratios (OR) and 95% confidence intervals. Results: AKI incidence was 40% according to pRIFLE and 48% according to AKIN and KDIGO. Sepsis (OR=10.29; 95%CI: 2.04-51.75) and moderate/severe dehydration (OR=3.67; 95%CI: 1.17-11.49) were significantly associated with severe AKI. Compared with KDIGO, AKIN showed better relative diagnostic performance (sensitivity 55%, specificity 86%, approximate AUC 0.71) than pRIFLE (sensitivity 48%, specificity 78%, approximate AUC 0.63). AKIN and KDIGO were significantly associated with the need for renal replacement therapy (OR=5.13; 95%CI: 1.21-21.60; p=0.04) and higher mortality risk (OR=3.14; 95%CI: 0.99-9.99; p=0.04), compared with pRIFLE. Conclusion: Although all three scales identify patients with AKI, AKIN and KDIGO showed better prognostic performance, particularly for predicting the need for renal replacement therapy, supporting their usefulness for risk stratification in critically ill pediatric patients.