Department of Epidemiology, University of Washington, Box 357236, Seattle, WA, 98195, USA,
Pediatr Nephrol. 2013 Nov;28(11):2199-206. doi: 10.1007/s00467-013-2544-2. Epub 2013 Jul 20.
We investigated prevalence of acute kidney injury (AKI) at hospitalization and its association with in-hospital mortality among Ugandan children hospitalized with common acute infections, and predictors of mortality among AKI children.
We enrolled 2,055 children hospitalized with primary diagnoses of acute gastroenteritis, malaria, or pneumonia. Serum creatinine, albumin, electrolytes, hemoglobin, and urine protein were obtained on admission. Participants were assessed for AKI based on serum creatinine levels. Demographic and clinical data were obtained using a primary care provider survey and medical chart review. Logistic regression was used to determine predictors of in-hospital mortality.
A total of 278 (13.5%) of children had AKI on admission; for 76.2%, AKI was stage 2 (98/278) or stage 3 (114/278) defined as serum creatinine >2- or 3-fold above normal upper limit for age, respectively. AKI prevalence was particularly high in gastroenteritis (28.6%) and underweight children (20.7%). Twenty-five percent of children with AKI died during hospitalization, compared to 9.9% with no AKI (adjusted odds ratio (aOR) 3.5 (95% CI, 2.2-5.5)). In-hospital mortality risk did not differ by AKI stage. Predictors of in-hospital mortality among AKI children included primary diagnosis of pneumonia, aOR 4.5 (95% CI, 1.8-11.2); proteinuria, aOR = 2.1 (95% CI, 1.0-4.9) and positive human immunodeficiency virus (HIV) status, aOR 5.0 (95% CI, 2.0-12.9).
Among children hospitalized with gastroenteritis, malaria, or pneumonia, AKI at admission was common and associated with high in-hospital mortality.
我们研究了在乌干达因常见急性感染住院的儿童中急性肾损伤（AKI）的患病率及其与院内死亡率的关系，以及 AKI 儿童死亡的预测因素。
我们纳入了 2055 名因急性胃肠炎、疟疾或肺炎而住院的儿童。入院时采集血清肌酐、白蛋白、电解质、血红蛋白和尿蛋白。根据血清肌酐水平评估参与者是否患有 AKI。通过初级保健提供者调查和病历回顾获取人口统计学和临床数据。使用逻辑回归确定院内死亡率的预测因素。
共有 278 名（13.5%）儿童入院时患有 AKI；对于 76.2%的儿童，AKI 为 2 期（98/278）或 3 期（114/278），定义为血清肌酐分别高于年龄正常上限的 2 倍或 3 倍。胃肠炎（28.6%）和体重不足儿童（20.7%）中 AKI 的患病率特别高。25%的 AKI 患儿在住院期间死亡，而无 AKI 患儿的死亡率为 9.9%（调整后比值比[aOR]为 3.5（95%可信区间，2.2-5.5））。AKI 分期与住院死亡率之间无差异。AKI 患儿院内死亡的预测因素包括肺炎的主要诊断，aOR 为 4.5（95%可信区间，1.8-11.2）；蛋白尿，aOR=2.1（95%可信区间，1.0-4.9）和 HIV 阳性，aOR=5.0（95%可信区间，2.0-12.9）。
在因胃肠炎、疟疾或肺炎住院的儿童中，入院时 AKI 很常见，且与高院内死亡率相关。
