先天性心脏手术中的急性肾损伤：儿科风险-损伤-衰竭-失功-终末期肾病与急性肾损伤网络

Acute kidney injury in congenital cardiac surgery: Pediatric risk-injury-failure-loss-end-stage renal disease and Acute Kidney Injury Network.

作者信息

Tanyildiz Murat, Ekim Mesiha, Kendirli Tanil, Tutar Ercan, Eyileten Zeynep, Ozcakar Zeynep Birsin, Kavaz Asli, Yalcınkaya Fatos, Uysalel Adnan, Atalay Semra

机构信息

Department of Pediatrics, Division of Pediatric Critical Care, Hacettepe University Medical School, Ankara, Turkey.

Pediatric Nephrology, Ankara University Faculty of Medicine, Ankara, Turkey.

出版信息

Pediatr Int. 2017 Dec;59(12):1252-1260. doi: 10.1111/ped.13359.

DOI:10.1111/ped.13359

PMID:28672079

Abstract

BACKGROUND

Acute kidney injury (AKI) is associated with an increased risk of mortality, especially in pediatric intensive care units. The aim of this study was to determine the risk factors of AKI in children undergoing cardiac surgery for congenital heart disease and to compare two different classification systems: pediatric risk-injury-failure-loss-end-stage renal disease (pRIFLE) and Acute Kidney Injury Network (AKIN).

METHODS

We retrospectively analyzed 145 patients undergoing pediatric congenital heart surgery who were between 1 month and 18 years of years, and treated at a cardiovascular surgery department from January 2009 to October 2011.

RESULTS

One hundred and thirty-seven patients (mean age, 36.6 ± 43.3 months) were enrolled: 84 (61.3%) developed AKI according to the pRIFLE criteria (25.5%, risk; 20.4%, injury; 15.3%, failure); and 65 patients (47.4%) developed AKI according to the AKIN criteria (15.3%, stage I; 18.2%, stage II; and 13.9%, stage III). Children younger than 11 months were more likely to develop AKI (P < 0.005). Longer cardiopulmonary bypass time was associated with an increased risk of AKI (P < 0.05). pRIFLE identified AKI more frequently than AKIN (P < 0.0005). pRIFLE may help in the early identification of patient at risk for AKI and seems to be more sensitive in pediatric patients (P < 0.05). Any degree of AKI in both classifications was associated with increased mortality (pRIFLE: OR, 15.1; AKIN: OR, 11.2; P = 0.007).

CONCLUSION

pRIFLE identified AKI more frequently than the AKIN criteria. pRIFLE identified patients at risk for AKI earlier, and was more sensitive in pediatric patients. Any degree of AKI in both classifications was associated with increased mortality. Both sets of criteria had the same association with mortality.

摘要

背景

急性肾损伤（AKI）与死亡风险增加相关，尤其是在儿科重症监护病房。本研究的目的是确定先天性心脏病心脏手术患儿发生AKI的危险因素，并比较两种不同的分类系统：儿科风险-损伤-衰竭-丢失-终末期肾病（pRIFLE）和急性肾损伤网络（AKIN）。

方法

我们回顾性分析了2009年1月至2011年10月在心血管外科接受治疗的145例年龄在1个月至18岁之间的儿科先天性心脏病手术患者。

结果

共纳入137例患者（平均年龄36.6±43.3个月）：根据pRIFLE标准，84例（61.3%）发生AKI（风险期25.5%；损伤期20.4%；衰竭期15.3%）；根据AKIN标准，65例（47.4%）发生AKI（I期15.3%；II期18.2%；III期13.9%）。11个月以下的儿童更易发生AKI（P<0.005）。体外循环时间延长与AKI风险增加相关（P<0.05）。pRIFLE比AKIN更频繁地识别出AKI（P<0.0005）。pRIFLE可能有助于早期识别有AKI风险的患者，并且在儿科患者中似乎更敏感（P<0.05）。两种分类中任何程度的AKI均与死亡率增加相关（pRIFLE：比值比，15.1；AKIN：比值比，11.2；P=0.007）。