Chowdhary Vikas, Vajpeyajula Ramya, Jain Mohit, Maqsood Syeda, Raina Rupesh, Kumar Deepak, Mhanna Maroun J
Division of Neonatology, Department of Pediatrics, Metro Health Medical Center, Case Western Reserve University, 2500 MetroHealth Drive, Cleveland, OH, 44109, USA.
Division of Pediatric Nephrology, Akron Children's Hospital, Akron, OH, USA.
Clin Exp Nephrol. 2018 Feb;22(1):117-125. doi: 10.1007/s10157-017-1430-9. Epub 2017 Jun 14.
The definition of acute kidney injury (AKI) has evolved over the years, and three definitions have been adapted including pediatric risk injury failure, loss of kidney function (pRIFLE), Acute Kidney Injury Network (AKIN), and Neonatal Modified Kidney Disease Improving Global Outcomes (KDIGO). We sought to report the prevalence and outcome of (AKI) according to the three existing definitions in extremely low birth weight (ELBW) infants.
In a retrospective cohort study, medical records of all ELBW infants (<1000 g) admitted to our neonatal intensive care unit (NICU) between Jan 2002 and Dec 2011 were reviewed. Infants' demographics, anthropometric measurements, and clinical characteristics were collected at the time of birth and at discharge from the NICU. Infants were staged according to the three different definitions.
During the study period, 483 ELBW infants met our inclusion criteria. The incidence of AKI was 56, 59, and 60% according to pRIFLE, AKIN, and KDIGO, respectively. Mortality, NICU length of stay, and serum creatinine (SCr) at NICU discharge were higher in infants with advanced AKI stages regardless of the definition. In addition, discharge NICU weight and length z scores were lower in infants with advanced AKI stages. SCr at 72 h of life and SCr peak were predictable of NICU mortality [AUC 0.667 (95% CI 0.604-0.731), p < 0.001 and AUC 0.747 (95% CI 0.693-0.801), p < 0.001, respectively].
Regardless of the definition, advanced AKI is associated with increased mortality, prolonged NICU length of stay, and poor growth in ELBW infants. SCr at 72 h of life and SCr peak may be predictable of NICU mortality.
急性肾损伤（AKI）的定义多年来不断演变，目前采用了三种定义，包括儿科风险损伤衰竭、肾功能丧失（pRIFLE）、急性肾损伤网络（AKIN）以及新生儿改良版改善全球肾脏病预后组织（KDIGO）标准。我们试图根据这三种现有定义报告极低出生体重（ELBW）婴儿中AKI的患病率及转归情况。
在一项回顾性队列研究中，我们查阅了2002年1月至2011年12月间入住我院新生儿重症监护病房（NICU）的所有ELBW婴儿（<1000g）的病历。收集婴儿出生时及从NICU出院时的人口统计学资料、人体测量数据及临床特征。根据三种不同定义对婴儿进行分期。
在研究期间，483例ELBW婴儿符合纳入标准。根据pRIFLE、AKIN和KDIGO标准，AKI的发生率分别为56%、59%和60%。无论采用哪种定义，AKI晚期婴儿的死亡率、NICU住院时间及NICU出院时的血清肌酐（SCr）水平均较高。此外，AKI晚期婴儿出院时NICU体重及身长Z评分较低。出生后72小时的SCr及SCr峰值可预测NICU死亡率[曲线下面积（AUC）分别为0.667（95%可信区间0.604 - 0.731），p < 0.001及AUC 0.747（95%可信区间0.693 - 0.801），p < 0.001]。
无论采用哪种定义，AKI晚期均与ELBW婴儿死亡率增加、NICU住院时间延长及生长发育不良相关。出生后72小时的SCr及SCr峰值可能可预测NICU死亡率。
