危重症儿童急性肾损伤后的肾功能随访及肾脏恢复情况

Renal Function Follow-Up and Renal Recovery After Acute Kidney Injury in Critically Ill Children.

作者信息

Hessey Erin, Ali Rami, Dorais Marc, Morissette Geneviève, Pizzi Michael, Rink Nikki, Jouvet Philippe, Lacroix Jacques, Phan Véronique, Zappitelli Michael

机构信息

1Department of Pediatrics, Division of Nephrology, Montreal Children's Hospital, McGill University Health Centre, Montreal, QC, Canada. 2Department of Family Medicine, GMF Centre Medical Hochelaga, Montreal, QC, Canada. 3Department of Family-Emergency Medicine, Hôpital Général de Hawkesbury and District General Hospital Inc, Hawkesbury, ON, Canada. 4StatScience Inc, Notre-Dame-de-l'Île-Perrot, QC, Canada. 5Department of Pediatrics, Pediatric Intensive Care unit, Centre mère-enfant Soleil, Centre hospitalier de l'Université Laval, Quebec, QC, Canada. 6Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, QC, Canada. 7Department of Pediatrics, Pediatric Intensive Care unit, Centre Hospitalier Universitaire Sainte-Justine, Montreal, QC, Canada. 8Department of Pediatrics, Division of Nephrology, Centre Hospitalier Universitaire Sainte-Justine, Montreal, QC, Canada.

出版信息

Pediatr Crit Care Med. 2017 Aug;18(8):733-740. doi: 10.1097/PCC.0000000000001166.

DOI:10.1097/PCC.0000000000001166

PMID:28492401

Abstract

OBJECTIVES

To evaluate factors associated with renal recovery from acute kidney injury in critically ill children and the extent to which serum creatinine is measured before discharge.

DESIGN

Retrospective cohort study.

SETTING

Two PICUs at tertiary centers in Montreal, QC, Canada.

PATIENTS

Children (< 18 yr old) admitted to the PICU between 2003 and 2005. Patients with end-stage renal disease, no healthcare number, died during admission, or admitted postcardiac surgery were excluded.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

Acute kidney injury was defined using internationally accepted criteria (Kidney Disease: Improving Global Outcomes). Two renal recovery outcomes commonly used in the literature were evaluated: hospital discharge serum creatinine less than 1.5 and less than 1.15 times baseline. Proportions of patients with 1) serum creatinine measurements between PICU and hospital discharge and 2) renal recovery were calculated. Univariate and multivariate analyses were performed to determine factors associated with serum creatinine monitoring and nonrecovery after acute kidney injury. Of 2,033 patients included, 829 (40.8%) had serum creatinine measurements between PICU and hospital discharge. The odds of having a discharge serum creatinine measurement increased with acute kidney injury severity (stages 1, 2, 3 adjusted odds ratio [95% CI]: 1.49 [1.03-2.15], 2.52 [1.40-4.54], 7.87 [3.16-19.60], respectively). Acute kidney injury recovery was 92.5% when defined as serum creatinine less than 1.5 times baseline versus 75.9% when defined as less than 1.15 times baseline (p < 0.001). Stage 3 acute kidney injury was associated with having a discharge serum creatinine greater than or equal to 1.5 times baseline (adjusted odds ratio = 3.51 [1.33-9.19]).

CONCLUSIONS

Less than half the PICU population had serum creatinine measured before hospital discharge. More severe acute kidney injury was associated with higher likelihood of serum creatinine monitoring and lower probability of acute kidney injury recovery. Future research should address knowledge translation on post-PICU acute kidney injury follow-up before hospital discharge.

摘要

目的

评估危重症儿童急性肾损伤后肾脏恢复的相关因素，以及出院前血清肌酐的检测情况。

设计

回顾性队列研究。

地点

加拿大魁北克省蒙特利尔市三级医疗中心的两个儿科重症监护病房。

患者

2003年至2005年间入住儿科重症监护病房的儿童（<18岁）。排除终末期肾病患者、无医疗编号患者、住院期间死亡患者或心脏手术后入院患者。

干预措施

无。

测量指标及主要结果

采用国际公认标准（《改善全球肾脏病预后》）定义急性肾损伤。评估文献中常用的两种肾脏恢复结局：出院时血清肌酐低于基线值的1.5倍和低于1.15倍。计算1）儿科重症监护病房与出院之间血清肌酐测量的患者比例，以及2）肾脏恢复的患者比例。进行单因素和多因素分析，以确定与急性肾损伤后血清肌酐监测及未恢复相关的因素。在纳入的2033例患者中，829例（40.8%）在儿科重症监护病房与出院之间进行了血清肌酐测量。出院时血清肌酐测量的几率随急性肾损伤严重程度增加而升高（1、2、3期调整优势比[95%CI]分别为：1.49[1.03 - 2.15]、2.52[1.40 - 4.54]、7.87[3.16 - 19.60]）。当将急性肾损伤恢复定义为血清肌酐低于基线值的1.5倍时，恢复率为92.5%；当定义为低于1.15倍时，恢复率为75.9%（p<0.001）。3期急性肾损伤与出院时血清肌酐大于或等于基线值的1.5倍相关（调整优势比 = 3.51[1.33 - 9.19]）。