Gordillo Roberto, Ahluwalia Tania, Woroniecki Robert
Department of Pediatrics, Division of Nephrology.
Department of Pediatrics, University of Illinois College of Medicine, Peoria, IL, USA.
Int J Nephrol Renovasc Dis. 2016 Aug 25;9:201-4. doi: 10.2147/IJNRD.S115096. eCollection 2016.
Hyperglycemia and acute kidney injury (AKI) are common in critically ill children and have been associated with higher morbidity and mortality. The incidence of AKI in children is difficult to estimate because of the lack of a standard definition for AKI. The pediatric RIFLE (Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease) criteria can be used to define AKI in children. Various biomarkers in urine and blood have been studied to detect AKI in critically ill children. However, it is not clear whether hyperglycemia is associated with AKI. Our objective was to evaluate the effect of hyperglycemia on kidney function and its effect on neutrophil gelatinase-associated lipocalin (NGAL) in children.
We studied retrospective and prospective cohorts of pediatric critically ill subjects admitted to the pediatric intensive care unit (PICU). We analyzed data from admission that included estimated glomerular filtration rate, plasma and urine NGAL, serum glucose and peak glycemia (highest glycemia during PICU admission), and length of hospital and PICU stay from two different institutions.
We found that the prevalence of hyperglycemia was 89% in the retrospective cohort and 86% in the prospective cohort, P=0.99. AKI was associated with peak glycemia, P=0.03. There was a statistically significant correlation between peak glycemia and hospital and PICU stays, P=<0.001 and P<0.001, respectively. Urine NGAL and plasma NGAL were not statistically different in subjects with and without hyperglycemia, P=0.99 and P=0.85, respectively. Subjects on vasopressors had lower estimated glomerular filtration rate and higher glycemia, P=0.01 and P=0.04, respectively.
We conclude that in critically ill children, hyperglycemia is associated with AKI and longer PICU stays.
高血糖和急性肾损伤（AKI）在危重症儿童中很常见，且与更高的发病率和死亡率相关。由于缺乏AKI的标准定义，儿童AKI的发病率难以估计。儿科RIFLE（风险、损伤、衰竭、肾功能丧失和终末期肾病）标准可用于定义儿童AKI。已对尿液和血液中的多种生物标志物进行研究，以检测危重症儿童的AKI。然而，尚不清楚高血糖是否与AKI相关。我们的目的是评估高血糖对儿童肾功能的影响及其对中性粒细胞明胶酶相关脂质运载蛋白（NGAL）的影响。
我们研究了入住儿科重症监护病房（PICU）的儿科危重症受试者的回顾性和前瞻性队列。我们分析了入院时的数据，包括估计肾小球滤过率、血浆和尿液NGAL、血糖和血糖峰值（PICU住院期间的最高血糖），以及来自两个不同机构的住院时间和PICU住院时间。
我们发现，回顾性队列中高血糖的患病率为89%，前瞻性队列中为86%，P = 0.99。AKI与血糖峰值相关，P = 0.03。血糖峰值与住院时间和PICU住院时间之间存在统计学显著相关性，分别为P < 0.001和P < 0.001。有高血糖和无高血糖的受试者尿液NGAL和血浆NGAL在统计学上无差异，分别为P = 0.99和P = 0.85。使用血管升压药的受试者估计肾小球滤过率较低且血糖较高，分别为P = 0.01和P = 0.04。
我们得出结论，在危重症儿童中，高血糖与AKI及更长的PICU住院时间相关。
