The prognostic value of serum creatinine dynamics in neonates
crossref(2024)
Victor Babeș University of Medicine and Pharmacy Timișoara
Abstract
Abstract Background: Acute kidney injury (nAKI) is common in neonates with increased mortality and hospitalization. Less is known about the creatinine dynamics outside acute kidney injury and impact on survival in new-borns in the first week of life. Methods: We performed an observational, retrospective, single-centre study on new-borns admitted to “Louis Turcanu” Emergency County Hospital for Children between 2014 and 2022. The cohort consisted in 1106 neonates with serum creatinine values recorded in the first day of life and at least another measurement between days 2 and 7. We evaluated the outcomes of ascending serum creatinine trend on mortality, hospital stay and chronic kidney disease development. Results: 23.4% (259) babies had an ascending trend of serum creatinine andhad on day one higher urea levels, lower haemoglobin and thrombocytes, lower serum proteins and higher degrees of inflammation compared to the ones with a descending trend. A rising creatinine increased the risk of nAKI in the first seven days by 12.93 times and overall nAKI by 4.07 times. Ascending creatinine trend independently increased mortality in the entire cohort by 1.92 times and 4.65 times in the subgroup of patients without AKI. In the crude analysis, ascending creatinine trend increased the risk of chronic kidney disease by 8.74 times and in adjusted model, only nAKI was an independent risk factor (8.57 times). Conclusions: Rising creatinine in the first week of life independently increased nAKI development and mortality. Even patients with small serum creatinine rises that did not reached nAKI presented higher mortality.
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