Fluid Overload, Renal Angina Index, and PICU Outcomes: Single-Center Retrospective Cohort, 2020-2024
George Briassoulis1, Stavroula Varda1, Eirini Marinopoulou1
1Postgraduate Program "Emergency and Intensive Care in Children, Adolescents and Young Adults," School of Medicine, University of Crete, Heraklion, Greece.
Summary
Fluid overload (FO) in critically ill children, including from fluid creep, significantly increases mortality risk. The Renal Angina Index (RAI) may help identify high-risk patients early.
Area of Science:
- Pediatric Critical Care Medicine
- Nephrology
- Intensive Care Research
Background:
- Fluid overload (FO) is a common complication in critically ill children, potentially impacting renal function and survival.
- Understanding the sources of FO, including "fluid creep" from continuous infusions and dilutions, is crucial for patient management.
- The Renal Angina Index (RAI) is a tool to assess renal stress in pediatric intensive care unit (PICU) patients.
Purpose of the Study:
- To evaluate the contribution of fluid input and output to FO in critically ill children.
- To examine the association between FO, fluid creep, and renal acute kidney injury (AKI).
- To investigate the relationship between FO, RAI, and mortality in this patient population.
Main Methods:
- A retrospective cohort study was conducted on critically ill children (1 month to 18 years) admitted to a single tertiary PICU for at least 72 hours between 2020 and 2024.
- Patients with pre-existing chronic kidney disease or congenital heart disease were excluded.
- Fluid balance, fluid types, renal function, and laboratory data were analyzed to define FO (cumulative fluid balance >5% or >10% body weight on day 3) and assess outcomes including PICU mortality and AKI.
Main Results:
- Among 217 patients, cumulative FO >5% and fluid creep were independently associated with increased odds of mortality (OR 4.01 and 1.01, respectively).
- Cumulative fluid input, output, and RAI were significantly associated with FO (p < 0.001).
- While the Pediatric Index of Mortality score demonstrated excellent discrimination for mortality (AUC 0.92), FO, fluid creep, RAI, and AKI showed acceptable discrimination (AUC 0.70-0.80).
Conclusions:
- Fluid overload, encompassing fluid creep, is linked to higher mortality in critically ill children requiring prolonged PICU stays (≥3 days).
- The RAI may serve as a valuable tool for early risk stratification in these vulnerable pediatric patients.
- Further research can explore interventions to mitigate FO and improve outcomes in critically ill children.
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