Athwani Vivek, Bhargava Maneesha, Chanchlani Rahul, Mehta Amar Jeet
Department of Pediatric Medicine, Division of Pediatric Nephrology, SMS Medical College, Jaipur, Rajasthan, 302004, India.
Division of Pediatric Nephrology, McMaster Children's Hospital, McMaster University, Hamilton, ON, Canada.
Indian J Pediatr. 2017 Jun;84(6):420-424. doi: 10.1007/s12098-017-2307-3. Epub 2017 Feb 27.
To determine the incidence, etiology and outcome of Cardiorenal syndrome (CRS) in hospitalized children.
A prospective cohort study was carried out in 242 children between 6 mo to 18 y of age hospitalized with primary cardiac, renal or any systemic disorder at a tertiary care center in India. The primary outcome was the development of CRS. Univariate and multivariate logistic regression analysis were performed to determine the risk of mortality secondary to CRS.
Among 242 children, 67 (27.7%) children developed CRS and the rest 175 (72.3%) did not. Among those with CRS, 40.3%, 20.9%, and 38.8% had CRS-1, 3 and 5, respectively. Cardiac diseases leading to CRS were myocarditis (40.7%) followed by congenital heart disease (25.9%), rheumatic heart disease (18.5%), and dilated cardiomyopathy (7.4%); renal disease associated with CRS was acute glomerulonephritis (100%) and major systemic disorders leading to CRS were septicemia (53.8%), malaria (23.1%), scrub typhus (7.7%), and acute gastroenteritis (3.8%). The occurrence of CRS was associated with an increased risk of mortality (OR 6.3, 95% CI: 2.8, 14.1; p 0.000). A subgroup analysis revealed that children with CRS having acute kidney injury stage 2 and 3 also had a higher risk of mortality (p 0.001).
The incidence of CRS is quite high in children with cardiac, renal or systemic diseases and is associated with a significant risk of mortality. Children presenting with these illnesses should be monitored for the occurrence of CRS so that early intervention may reduce mortality.
确定住院儿童心肾综合征（CRS）的发病率、病因及转归。
在印度一家三级医疗中心，对242例6个月至18岁因原发性心脏、肾脏或任何系统性疾病住院的儿童进行了一项前瞻性队列研究。主要结局是CRS的发生。采用单因素和多因素逻辑回归分析来确定CRS继发死亡的风险。
242例儿童中，67例（27.7%）发生CRS，其余175例（72.3%）未发生。在发生CRS的儿童中，分别有40.3%、20.9%和38.8%患有CRS-1、3和5型。导致CRS的心脏疾病依次为心肌炎（40.7%）、先天性心脏病（第二十五点九%）、风湿性心脏病（18.5%）和扩张型心肌病（7.4%）；与CRS相关的肾脏疾病为急性肾小球肾炎（100%），导致CRS的主要系统性疾病为败血症（53.8%）、疟疾（23.1%）、恙虫病（7.7%）和急性胃肠炎（3.8%）。CRS的发生与死亡风险增加相关（比值比6.3，95%置信区间：2.8，14.1；P<0.000）。亚组分析显示，患有急性肾损伤2期和3期的CRS儿童死亡风险也较高（P<0.001）。
患有心脏、肾脏或系统性疾病的儿童中CRS发病率相当高，且与显著的死亡风险相关。应监测患有这些疾病的儿童CRS的发生情况，以便早期干预可能降低死亡率。
