P2.102: Optimizing Malnutrition Screening as a Predictor of Acute Kidney Injury and ICU Outcomes in Critically Ill Children

Background: Malnutrition and acute kidney injury (AKI) are both independent risks factor for poor outcomes in critically ill pediatric patients. Patients with AKI are at greater risk of malnutrition, but it is uncertain whether malnutrition is associated with AKI in pediatric intensive care unit (PICU) patients. Early identification of malnutrition can identify patients for whom nutritional interventions will be most impactful. Currently, malnutrition is assessed using weight-for-length (WFL) and body mass index (BMI) Z-scores in the PICU. However, several anthropometric measures are available, including weight-for-age (WFA), length-for-age (LFA), and mid-upper arm circumference (MUAC). It is unknown which measure, if any, has the strongest association with AKI and PICU outcomes.

Methods: We conducted a prospective observational cohort study of PICU patients aged 0–21 years who were at high risk for AKI. We extracted basic anthropometrics from the electronic health record (EHR) and measured MUAC. Malnutrition was defined as moderate/severe by Z-scores of ≤-2, per World Health Organization criteria. AKI was defined by Kidney Disease: Improving Global Outcomes serum creatinine and urine output criteria, which was abstracted from the EHR. We used Fisher’s Exact Test to assess associations between anthropometric measure and AKI and ICU outcomes.

Results: We enrolled 37 patients (Table 1) with a median [IQR] age of 6.3 [2.4-13.8] years, weight of 20.6 [12.5-39.1] kg, of whom 16 (42%) were female and 9 (24.3%) were White. Thirteen (34%) patients had AKI. Median [IQR] PICU LOS was 8.8 [2.85-13.43] days, and 5 patients died in the PICU (14.7%). Only 4 (11.1%) patients met criteria for malnutrition by WFL and BMI criteria, while 13 (36.1%), 5 (21.7%), and 0 (0%) met criteria by LFA, WFA, and MUAC respectively. Patients with AKI did not have worse nutritional status by any measure, (although 15% vs 8.3% of patients with AKI met malnutrition criteria by BMI). Malnutrition by BMI was associated with a PICU LOS < 7 days (p = 0.018). No other anthropometric measures were associated with PICU LOS or mortality (Table 2).

Conclusion: LFA and WFA may identify malnutrition more frequently than BMI and WFL; however, their ability to predict ICU outcomes remains uncertain. Contrary to our hypotheses, malnutrition by BMI appears to be associated with shorter ICU LOS; further research is needed to clarify this relationship. The absence of significant associations between malnutrition and AKI or mortality suggests that malnutrition alone may not be the primary determinant of these outcomes, or that our sample size was insufficient to detect true effects.