(695) Updated Fluid Overload Kidney Injury Score and Outcomes in Critically Ill Children

Introduction: Systemic inflammation with endothelial injury, high volume fluid administration, and nephrotoxic medications predispose critically ill patients to acute kidney injury (AKI). Prompt diagnosis of AKI is challenging due to delayed rise in serum creatinine (Scr) and the variability of SCr based on age and body habitus. The updated Fluid Overload Kidney Injury Score (kFOKIS) combines the additive deleterious effects of cumulative fluid overload, SCr elevation, and nephrotoxin exposure into one clinical score of total kidney injury.

Methods: We updated FOKIS, a real-time, multidimensional clinical score with the Kidney Disease: Initiative on Global Outcomes (KDIGO) criteria for elevations in SCr. We calculated kFOKIS using a scale of 0-5 for fluid overload percentage from baseline admission weight, 0-3 for elevation in SCr, and +1 for each medication administered from a predetermined list of nephrotoxic agents. We performed an observational study of all children with a documented admission weight in all pediatric intensive care units (PICU) at a quaternary children’s hospital from January 2021 to June 2022. We hypothesized that elevated peak FOKIS above a threshold value would correlate with increased mortality.

Results: We included data from 3,433 patients admitted during the 18-month timeframe, with a range of peak kFOKIS from 0-10 and an overall mortality of 3.8% (129/3433). 268 patients received a peak kFOKIS of ≥ 6, with a mortality rate of 12.7% (p < 0.001). 75 patients received a peak kFOKIS of ≥ 7, with a mortality rate of 21.3% (p < 0.001).

Conclusions: In our preliminary analyses, increased peak kFOKIS in a cohort of PICU patients was associated with increased mortality. Leveraging the current accepted definition of pediatric AKI allows for future studies examining the generalizability of these findings across multiple institutions. Future directions for kFOKIS include examination of its utility as a bedside clinical predictor tool for other adverse patient outcomes, including ventilator associated events and prolonged hospitalizations.