Early Lactate Clearence During Therapeutic Hypothermia Predicts Acute Kidney Injury in Hypoxic Ischemic Encephalopathy

Background Acute kidney injury (AKI) is an important complication in neonates with hypoxic ischemic encephalopathy (HIE). The aim is to assess the association between early lactate clearance and development of AKI in neonates with HIE receiving therapeutic hypothermia. Methods Medical records of 257 neonates with moderate-severe HIE were retrospectively analyzed for development of AKI based on neonatal Kidney Disease Improving Global Outcomes (KDIGO) criteria. Blood lactate values over time for the first 5 days were recorded. The percentage decrease in lactate values were calculated during the first 12 hours and on daily basis and reported as lactate clearance. Logistic regression analysis and receiver operating characteristics curve (ROC) analysis were conducted. Results AKI developed in 70 neonates (27.2%). Median initial and 12-hour lactate values were significantly higher in AKI group. Lactate clearance at 12-hour was significantly lower in AKI group compared to neonates with no AKI (43.6% vs 61.4%, p < 0.001). Lower 12-hour lactate clearance was associated with development of AKI (OR: 21.27, 95%CI: 6.73–67.17, p < 0.001). ROC curve analysis demonstrated a 47.5% decrease in lactate values at 12-hour as critical cut off value of lactate clearance with 90% specificity and 64% sensitivity to predict AKI. Area under curve was found to be 0.813 (95% CI:0.76–0.86, p < 0.001). Conclusion Lactate clearance in the first 12 hours can be used as an early marker for AKI in neonates with HIE receiving therapeutic hypothermia. The presence of decreased lactate clearance will allow for careful fluid management and early medical interventions in this highly vulnerable patient population.