Predictors of mortality in late preterm and term neonates with acute kidney injury using modified neonatal Kidney Disease: Improving Global Outcomes criteria: A prospective observational study

Abstract: Background: Acute kidney injury (AKI) is a common complication among critically ill neonates and is associated with increased morbidity and mortality. Objective: The objective of the study was to identify clinical and biochemical predictors of mortality among late preterm and term neonates with AKI using modified neonatal Kidney Disease: Improving Global Outcomes criteria. Methods: This prospective observational study included neonates ≥34 weeks of gestation admitted to a tertiary neonatal intensive care unit. Serial serum creatinine (SCr) measurements were performed after the second postnatal day and repeated after 48 h. Urine output (UOP) was monitored six-hourly throughout hospitalization. The primary outcome was in-hospital mortality among neonates with AKI. Risk factors were analyzed using univariate analysis and parsimonious multivariable logistic regression. Adjusted odds ratios (aORs) with 95% confidence intervals (CI) were calculated. Statistical significance was defined as P < 0.05. Results: Among 756 screened neonates, 82 developed AKI. Mortality was 20.7%. Mechanical ventilation, hypotension, metabolic acidosis, oliguria, hyperkalemia, elevated SCr, and reduced UOP were significantly associated with mortality on univariate analysis. Regression identified oliguria (aOR 5.32, 95% CI: 1.46–19.33; P = 0.01), hyperkalemia (aOR 5.02, 95% CI: 1.33–18.97; P = 0.01), and mechanical ventilation (aOR 12.23, 95% CI: 1.33–112.30; P = 0.02) as independent predictors of mortality. Mortality was higher in stage III AKI (62.5%) compared to stage II (38.5%) and stage I (11.5%) ( P = 0.002). Oliguric AKI had significantly higher mortality than nonoliguric AKI (45.8% vs. 10.3%, P = 0.001). Conclusion: Oliguria, mechanical ventilation, and hyperkalemia were independent predictors of mortality, while advanced AKI stage, hypotension, and metabolic acidosis were significantly associated with poor outcomes.