Prediction of Acute Kidney Injury in Critically-Ill Pediatric Patients Admitted to PICU: The Role of Serum Cystatin C And Serum Interleukin-18

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Objectives: We conducted this study to assess the sensitivity and specificity of serum cystatin C (sCysC) and serum interleukin-18 (IL-18) in comparison with serum creatinine and serum urea for early detection of acute kidney injury (AKI) in critically-ill pediatric patients admitted to the pediatric intensive care unit (PICU). Methods: This was an observational case-control study enrolled 61 patients admitted in PICU divided into two groups (the case group 30 patients with proposed AKI and the control group 31 control individuals). After complete clinical evaluation, electrolyte profile, including Na and K besides the biomarkers assay of serum creatinine, urea, sCysC , and IL-18 were measured at the first day of admission and after three days.
Results: Urea and creatinine were increased at admission in only three patients and two patients, respectively, while it dramatically increased in 25 patients in both urea and creatinine separately on the third day of admission. sCysC and sIL-18 showed a high diagnostic ability for detecting AKI at admission with AUCs of 0.877 and 0.819 respectively. Supportingnly, sCysC and IL-18 were significantly higher in AKI group compared to the control group. Conclusions: sCysC and serum IL-18 proved their accuracy in prediction of AKI in patients admitted to the PICU. Their diagnostic ability was superior to serum creatinine, serum urea, and even urinary IL-18 and CysC.

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