Critical values were determined by analysis of the 269 children in the training set, who showed optimal neurodevelopmental outcome at two years of corrected age. To define critical values for serum creatinine levels by gestational age in preterm infants, as a predictive factor for mortality and morbidity. Nevertheless, serum creatinine is the most commonly and easily used marker of renal function. Since changes in serum sodium levels affect neurodevelopmental outcome, the variations in serum sodium levels between infants with HSCr values greater than or less than the critical cut-off value were studied [24]. Fluid loss, like sweating, drinking less water and frequent urine. // For more information about PLOS Subject Areas, click Importantly, risk factors for HSCr above the critical values were similar to risk factors for renal failure described in the literature [1,4,10]. Am J Clin Pathol. www.pkdclinic.org > High Creatinine Levels >. Although our dosage kit is standardized with isotopic dilution mass spectrometry and validated as having minimal interference with chromogens such as bilirubin, this is not the gold standard method and recommendations for best practices have proposed the use of an enzymatic assay for analysis of serum creatinine in children [33,34]. However, CLIA does not specify which tests (or associated values) are considered “imminently life threatening”. Other cohort studies have noted similar evolutions of serum creatinine levels over time [8,10-12], with peak values reported in the first days of life, followed by a progressive decrease. In the validation set (n=976), a serum creatinine level above the critical value was significantly associated with neonatal mortality (Odds ratio: 8.55 (95% confidence interval: 4.23-17.28); p<0.01) after adjusting for known renal failure risk factors, and with non-optimal neurodevelopmental outcome at two years (odds ratio: 2.06 (95% confidence interval: 1.26-3.36); p=0.004) before adjustment. Analyzed the data: AB JCR EAL. In addition, for this discussion, I did a GOOGLE search of the terms “critical value” and creatinine. Neonatal characteristics and renal risk factors already reported in literature [14], were noted for each patient. Conceived and designed the experiments: JCR CF US GRK. The sponsor has no role in this manuscript. previousï¼What Can I Expect with Creatinine Reading of 637, nextï¼What Chinese Medicine Helps Reduce Creatinine 5.7. A psychomotor developmental quotient (DQ) was calculated after assessment using the revised Brunet-Lezine test [25], with a score <85 indicating non-optimal psychomotor development. Adjustment for GA, birth weight Z-score, sex, risk factors for HSCr > critical values and diuretic treatment. The increase in serum creatinine value is a marker of the severity of the illness in preterm newborns, strongly associated with mortality. Tiredness due to over work or lack of rest. Yes Author: David Alter 1: Genzen JR, Tormey CA; Education Committee of the Academy of Clinical, Laboratory Physicians and Scientists. Yes Competing interests: The authors have declared that no competing interests exist. What is the clinical utility for critical creatinine value notification? This is a retrospective cohort study of clinical and biological data recorded prospectively. https://doi.org/10.1371/journal.pone.0084892.g001. // However, after adjusting for confounding variables (except for changes in sodium), we found the association to be at the limit of significance. Those therapies aim at repairing the damaged kidneys. Yes Science & Research Yes Of the 1,614 children studied, 153 had not had their creatinine levels measured. This could be a limitation in using these definitions of AKI based on an increase of serum creatinine from the previous value. https://doi.org/10.1371/journal.pone.0084892.s001. This was a retrospective study of all preterm infants born before 33 weeks of gestational age, hospitalized in Nantes University Hospital NICU between 2003 and 2009, with serum creatinine levels measured between postnatal days 3 to 30. Here, we focused on proposing critical values for serum creatinine, which have predictive power for patient outcome, providing clinicians with a method to detect children at high risk of mortality and allowing them to take the appropriate measures. Characteristics of children in the training and validation groups. Creatinine, Blood/Plasma/Serum 2 yrs-11 yrs - ≥ 2.5 mg/dL Creatinine, Blood/Plasma/Serum 12 yrs-15 yrs - ≥ 3.0 mg/dL Creatinine, Blood/Plasma/Serum ≥ 16 yrs - ≥ 10.0 mg/dL Am J Clin Pathol. Critical creatinine values were defined within the training set as the 90th percentile values of highest serum creatinine (HSCr) in infants with optimal neurodevelopmental at two years of age. Based on that logic, one could argue that there are only a very small number of test/result combinations that are truly imminently life threatening. In the typical hospital laboratory setting, markedly elevated creatinine values are endemic with presumably most of them due to known patients on dialysis or with late stage chronic kidney disease. The calculation of critical serum creatinine values according to GA will be helpful in clinical practice and research, but these critical values must now be tested and validated in other cohorts of preterm infants. The 90th percentile HSCr values from this population were used to define the critical values for each GA subgroup, which were found to be 1.6 mg/dL at 24-27 weeks, 1.1 mg/dL at 28-29 weeks, and 1.0 mg/dL at 30-32 weeks. Initial data related to the pregnancy, delivery, and medical care of these infants were prospectively recorded during hospitalization in the maternal and neonatal units and were then retrospectively collected and analyzed. Chinese Herbs The healthy kidney have a strong compensatory ability. No, Is the Subject Area "Morbidity" applicable to this article? Acute elevations in serum creatinine levels do occur but are typically in response to acute etiologies of renal failure which are typically not imminently life threatening and when due to life threatening conditions; the clinical picture and etiology is usually quite evident e.g shock secondary to “pick your etiology”. Renal failure in neonates is associated with an increased risk of mortality and morbidity. The critical values determined in the training set (n=485) were 1.6, 1.1 and 1.0 mg/dL for each gestational age group, respectively. No, Is the Subject Area "Renal failure" applicable to this article? Also, in cases where neurological impairment was too severe for the child to take the test, he/she was included in the non-optimal psychomotor development group. However, there is currently no consensus on the thresholds established for the diagnosis of acute renal failure. Funding: The LIFT cohort is supported by grants from the Regional Health Agency of Pays de la Loire. Critical value notification is a CLIA mandated laboratory practice whereas providers need to be urgently notified of any “…any test result that indicates an imminent life threatening condition...”. Approval of the use of the data for this study was obtained from the institutional review board of the University Hospital of Nantes, and parents gave written informed consent before infants were enrolled in follow-up. Due to the correlation between GA and birth weight, we used the weight Z-score index to assess the role of intrauterine growth. Date: OCT.10.2017 The association between changes in serum sodium and outcome was also assessed by logistic regression. In the literature, it is difficult to find a consensus regarding the definition of renal impairment in preterm infants. PLoS ONE 8(12): Data after day 30 were not taken into account because of the low frequency of renal injury after the first month of life in premature infants. 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