Miklaszewska Monika, Korohoda Przemysław, Sobczak Alina, Horbaczewska Anna, Filipiak Agata, Zachwieja Katarzyna, Kobylarz Krzysztof, Tkaczyk Marcin, Drożdż Dorota, Pietrzyk Jacek A
Department of Pediatric Nephrology, Jagiellonian University Medical College, Kraków, Poland.
Kidney Blood Press Res. 2014;39(1):28-39. doi: 10.1159/000355774. Epub 2014 May 9.
BACKGROUND/AIMS: The recent improvements of management of patients in pediatric intensive care units (PICU) are associated with improved outcome. However, this decrease in mortality is associated with an increased number of children with acute kidney injury (AKI), especially in patients with multiorgan failure.
The report presents a retrospective analysis of 25 cases of AKI (assessed based on the pRIFLE criteria) in PICU within 7 years.
AKI was diagnosed in 1.24% of all hospitalized children. AKI percentage duration (as compared to the total hospitalization time) in the children who died vs. the survivors was 79.55% vs. 46.19%, respectively (p<0.05). The mortality rate of AKI patients was 40% which was 4.4-times higher as compared to the total mortality rate in PICU. The final cumulative survival ratio (FCSR) of patients meeting the oliguria criterion (which was met in 48% of AKI patients) was 37% vs. 49% in non-oliguric children. Averaged urine output values in the first week of hospitalization in the deceased vs. survivors were 1.49 vs. 2.57 ml/kg/h, respectively (p<0.05).
Oliguria should not be considered as a sensitive parameter for AKI diagnosing in children below one year of age. A decreased mean urine output in the first week of PICU hospitalization (less than 1.4 ml/kg/h) should be considered as a poor prognostic factor. In many cases AKI was diagnosed too infrequently and too late.
背景/目的：儿科重症监护病房（PICU）患者管理的近期改善与预后改善相关。然而，死亡率的降低与急性肾损伤（AKI）患儿数量的增加有关，尤其是在多器官功能衰竭患者中。
本报告对7年内PICU中25例AKI病例（根据pRIFLE标准评估）进行了回顾性分析。
在所有住院儿童中，AKI的诊断率为1.24%。死亡儿童与存活儿童的AKI持续时间百分比（相对于总住院时间）分别为79.55%和46.19%（p<0.05）。AKI患者的死亡率为40%，是PICU总死亡率的4.4倍。符合少尿标准的患者（48%的AKI患者符合该标准）的最终累积生存率（FCSR）为37%，而非少尿儿童为49%。死亡患者与存活患者住院第一周的平均尿量分别为1.49和2.57 ml/kg/h（p<0.05）。
少尿不应被视为1岁以下儿童AKI诊断的敏感参数。PICU住院第一周平均尿量减少（低于1.4 ml/kg/h）应被视为不良预后因素。在许多情况下，AKI的诊断频率过低且过晚。
