{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,10]],"date-time":"2026-03-10T15:30:20Z","timestamp":1773156620793,"version":"3.50.1"},"reference-count":26,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2020,11,11]],"date-time":"2020-11-11T00:00:00Z","timestamp":1605052800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Acute kidney injury (AKI) is a major complication of sepsis that induces acid-base imbalances. While creatinine levels are the only indicator for assessing the prognosis of AKI, prognostic importance of metabolic acidosis is unknown. We conducted a retrospective observational study by analyzing a large China-based pediatric critical care database from 2010 to 2018. Participants were critically ill children with AKI admitted to intensive care units (ICUs). The study included 1505 children admitted to ICUs with AKI, including 827 males and 678 females. The median age at ICU admission was 22 months (interquartile range 7\u201365). After a median follow-up of 10.87 days, 4.3% (65 patients) died. After adjusting for confounding factors, hyperlactatemia, low pH, and low bicarbonate levels were independently associated with 28-day mortality (respective odds ratio: 3.06, 2.77, 2.09; p values: &lt;0.01, &lt;0.01, &lt;0.01). The infection had no interaction with the three parameters. The AKI stage negatively interacted with bicarbonate and pH but not lactate. The current study shows that among children with AKI, hyperlactatemia, low pH, and hypobicarbonatemia are associated with 28-day mortality.<\/jats:p>","DOI":"10.3390\/diagnostics10110937","type":"journal-article","created":{"date-parts":[[2020,11,11]],"date-time":"2020-11-11T19:08:28Z","timestamp":1605121708000},"page":"937","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["Prognostic Impact of Parameters of Metabolic Acidosis in Critically Ill Children with Acute Kidney Injury: A Retrospective Observational Analysis Using the PIC Database"],"prefix":"10.3390","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0758-4988","authenticated-orcid":false,"given":"Hikaru","family":"Morooka","sequence":"first","affiliation":[{"name":"Department of Emergency and Critical Care Medicine, Nagoya University Graduate School of Medicine, Nagoya 466-8560, Japan"},{"name":"Department of Nephrology, Nagoya University Hospital, Nagoya 466-8560, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8692-3003","authenticated-orcid":false,"given":"Daisuke","family":"Kasugai","sequence":"additional","affiliation":[{"name":"Department of Emergency and Critical Care Medicine, Nagoya University Graduate School of Medicine, Nagoya 466-8560, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8866-5901","authenticated-orcid":false,"given":"Akihito","family":"Tanaka","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Nagoya University Hospital, Nagoya 466-8560, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masayuki","family":"Ozaki","sequence":"additional","affiliation":[{"name":"Department of Emergency and Critical Care Medicine, Komaki City Hospital, Komaki 485-8520, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Atsushi","family":"Numaguchi","sequence":"additional","affiliation":[{"name":"Department of Emergency and Critical Care Medicine, Nagoya University Graduate School of Medicine, Nagoya 466-8560, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shoichi","family":"Maruyama","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Nagoya University Graduate School of Medicine, Nagoya 466-8560, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2020,11,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1056\/NEJMoa1611391","article-title":"Epidemiology of acute kidney injury in critically ill children and young adults","volume":"376","author":"Kaddourah","year":"2017","journal-title":"N. Engl. J. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1482","DOI":"10.2215\/CJN.00710113","article-title":"Acute Kidney Injury Advisory Group of the American Society of Nephrology. World incidence of AKI: A meta-analysis","volume":"8","author":"Susantitaphong","year":"2013","journal-title":"Clin. J. Am. Soc. Nephrol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"384","DOI":"10.1053\/j.ajkd.2015.07.019","article-title":"Acute kidney injury incidence in noncritically ill hospitalized children, adolescents, and young adults: A retrospective observational study","volume":"67","author":"McGregor","year":"2016","journal-title":"Am. J. Kidney Dis."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e229","DOI":"10.1097\/PCC.0000000000000685","article-title":"Epidemiology and outcome of acute kidney injury according to pediatric risk, injury, failure, loss, end-stage renal disease and kidney disease: Improving global outcomes criteria in critically ill children-a prospective study","volume":"17","author":"Volpon","year":"2016","journal-title":"Pediatr. Crit. Care Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"2432","DOI":"10.1681\/ASN.2018010090","article-title":"A new criterion for pediatric AKI based on the reference change value of serum creatinine","volume":"29","author":"Xu","year":"2018","journal-title":"J. Am. Soc. Nephrol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1481","DOI":"10.1007\/s00134-014-3391-8","article-title":"Validation of the KDIGO acute kidney injury criteria in a pediatric critical care population","volume":"40","author":"Selewski","year":"2014","journal-title":"Intensive Care Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"948","DOI":"10.2215\/CJN.05431207","article-title":"Ascertainment and epidemiology of acute kidney injury varies with definition interpretation","volume":"3","author":"Zappitelli","year":"2008","journal-title":"Clin. J. Am. Soc. Nephrol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1028","DOI":"10.1038\/sj.ki.5002231","article-title":"Modified RIFLE criteria in critically ill children with acute kidney injury","volume":"71","author":"Zappitelli","year":"2007","journal-title":"Kidney Int."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"c179","DOI":"10.1159\/000339789","article-title":"KDIGO clinical practice guidelines for acute kidney injury","volume":"120","author":"Khwaja","year":"2012","journal-title":"Nephron Clin. Pract."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"204","DOI":"10.1016\/j.ajem.2018.05.012","article-title":"Septic acute kidney injury patients in emergency department: The risk factors and its correlation to serum lactate","volume":"37","author":"Hsu","year":"2019","journal-title":"Am. J. Emerg Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1016\/j.jcrc.2007.12.017","article-title":"Timing of renal replacement therapy and clinical outcomes in critically ill patients with severe acute kidney injury","volume":"24","author":"Bagshaw","year":"2009","journal-title":"J. Crit. Care"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"801","DOI":"10.1001\/jama.2016.0287","article-title":"The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3)","volume":"315","author":"Singer","year":"2016","journal-title":"JAMA"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1127","DOI":"10.1016\/j.mayocp.2013.06.012","article-title":"Etiology and therapeutic approach to elevated lactate levels","volume":"88","author":"Andersen","year":"2013","journal-title":"Mayo Clin. Proc."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1453","DOI":"10.1007\/s00467-010-1541-y","article-title":"Etiology and outcome of acute kidney injury in children","volume":"25","author":"Duzova","year":"2010","journal-title":"Pediatr. Nephrol."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Bai, Z., Zhu, X., Li, M., Hua, J., Li, Y., Pan, J., Wang, J., and Li, Y. (2014). Effectiveness of predicting in-hospital mortality in critically ill children by assessing blood lactate levels at admission. BMC Pediatr., 14.","DOI":"10.1186\/1471-2431-14-83"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1016\/j.lfs.2016.01.007","article-title":"Metabolic acidosis aggravates experimental acute kidney injury","volume":"146","author":"Freire","year":"2016","journal-title":"Life Sci."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1038\/s41597-020-0355-4","article-title":"PIC, a paediatric-specific intensive care database","volume":"7","author":"Zeng","year":"2020","journal-title":"Sci. Data"},{"key":"ref_18","unstructured":"Zivetz, L. (1992). The ICD-10 Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines, World Health Organization."},{"key":"ref_19","first-page":"30","article-title":"Multiple imputation with multivariate imputation by chained equation (MICE) package","volume":"4","author":"Zhang","year":"2016","journal-title":"Ann. Transl. Med."},{"key":"ref_20","first-page":"1","article-title":"Mice: Multivariate imputation by chained equations in R","volume":"45","year":"2011","journal-title":"J. Stat. Softw."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1","DOI":"10.18637\/jss.v075.i07","article-title":"Just another Gibbs addictive modeler: Interfacing JAGS and mgcv","volume":"75","author":"Wood","year":"2016","journal-title":"J. Stat. Softw."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1135","DOI":"10.1016\/j.amjmed.2017.05.042","article-title":"Calculated bicarbonate for acid-base disorders","volume":"130","author":"Tanemoto","year":"2017","journal-title":"Am. J. Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"998","DOI":"10.1016\/j.jcrc.2015.06.021","article-title":"Sepsis may not be a risk factor for mortality in patients with acute kidney injury treated with continuous renal replacement therapy","volume":"30","author":"Nagata","year":"2015","journal-title":"J. Crit. Care"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1499","DOI":"10.1021\/ed078p1499","article-title":"The Henderson-Hasselbalch equation: Its history and limitations","volume":"78","author":"Po","year":"2001","journal-title":"J. Chem. Educ."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"R60","DOI":"10.1186\/cc2333","article-title":"Acid-base status of critically ill patients with acute renal failure: Analysis based on Stewart-Figge methodology","volume":"7","author":"Rocktaeschel","year":"2003","journal-title":"Crit Care"},{"key":"ref_26","unstructured":"Edemekong, P.F., Annamaraju, P., and Haydel, M.J. (2020, October 11). Health Insurance Portability and Accountability Act, (HIPAA). StatPearls, Available online: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK500019\/."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/10\/11\/937\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T10:32:00Z","timestamp":1760178720000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/10\/11\/937"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,11,11]]},"references-count":26,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2020,11]]}},"alternative-id":["diagnostics10110937"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics10110937","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,11,11]]}}}