Nawaz Shariq, Afzal Kamran
Division of Nephrology, Department of Pediatrics, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India.
Saudi J Kidney Dis Transpl. 2018 May-Jun;29(3):689-697. doi: 10.4103/1319-2442.235172.
The conducted study aimed to determine the incidence and clinical profile of acute kidney injury (AKI) in hospitalized patients using the AKI Network (AKIN) criteria. This prospective observational study was conducted at the Pediatric ward and pediatric Intensive Care Unit of a tertiary level teaching hospital in North India. The participants were 763 consecutive patients aged three months to 12 years from January 2014 to October 2015 and were assessed for eligibility. Of these, 163 patients were excluded from the study. Main outcome measure was incidence of AKI based on the AKIN criteria. Factors associated with AKI were analyzed. A total of 600 patients (141 critically ill and 459 noncritically ill) were enrolled. The incidence of AKI was 25.2% (n = 151); it was significantly higher among critically ill (53.2%) than non-critically ill patients (16.6%), P <0.001. Most patients with AKI were in Stage 1 (n = 99; 65.6%). Ten patients (6.6%) required dialysis (peritoneal dialysis n = 8; hemodialysis n = 2). Patient with AKI had significantly higher median (interquartile range) PIM-2 score, 22.6 (5-61.7), longer hospital stay (10 vs. 7 days), and mortality rate (28.5% vs. 3.6%); P <0.001. Nephrotoxic drugs [hazard ratio (HR): 5.5, 95% confidence interval (CI): 2.6-11.4; P = 0.001]; hypovolemia (HR: 1.7, 95% CI: 1-2.7; P = 0.035); sepsis (HR 2.3, 95% CI: 1.1-5); and mechanical ventilation (HR: 3.3, 95% CI: 1.6-6.8) were independent predictors for AKI. AKI was an independent risk factor for mortality and risk increased with increasing stage of AKI. Mortality was significantly higher in Stage 3 AKI (n = 14; 60.9%); P <0.001. Independent predictors for mortality in AKI were acidosis (HR: 3.6; 95% CI 1.5-8.6), mechanical ventilation (HR: 34; 95% CI 9.3-123), shock (HR: 19.7; 95% CI 2-194), and sepsis (HR: 3; 95% CI 1-8). The incidence of AKI is high among pediatric patients admitted to this center, including among noncritically ill children. AKI is associated with significantly increased morbidity and mortality.
本研究旨在使用急性肾损伤网络（AKIN）标准确定住院患者急性肾损伤（AKI）的发病率和临床特征。这项前瞻性观察性研究在印度北部一家三级教学医院的儿科病房和儿科重症监护病房进行。研究对象为2014年1月至2015年10月期间年龄在3个月至12岁的763例连续患者，并对其进行了资格评估。其中，163例患者被排除在研究之外。主要结局指标是基于AKIN标准的AKI发病率。分析了与AKI相关的因素。共纳入600例患者（141例危重症患者和459例非危重症患者）。AKI的发病率为25.2%（n = 151）；危重症患者中的发病率（53.2%）显著高于非危重症患者（16.6%），P <0.001。大多数AKI患者处于1期（n = 99；65.6%）。10例患者（6.6%）需要透析（腹膜透析n = 8；血液透析n = 2）。AKI患者的中位（四分位间距）PIM-2评分显著更高，为22.6（5 - 61.7），住院时间更长（10天对7天），死亡率更高（28.5%对3.6%）；P <0.001。肾毒性药物[风险比（HR）：5.5，95%置信区间（CI）：2.6 - 11.4；P = 0.001]；血容量不足（HR：1.7，95%CI：1 - 2.7；P = 0.035）；脓毒症（HR 2.3，95%CI：1.1 - 5）；以及机械通气（HR：3.3，95%CI：1.6 - 6.8）是AKI的独立预测因素。AKI是死亡的独立危险因素，且随着AKI分期增加风险升高。3期AKI患者的死亡率显著更高（n = 14；60.9%）；P <0.001。AKI患者死亡的独立预测因素是酸中毒（HR：3.6；95%CI 1.5 - 8.6）、机械通气（HR：34；95%CI 9.3 - 123）、休克（HR：19.7；95%CI 2 - 194）和脓毒症（HR：3；95%CI 1 - 8）。该中心收治的儿科患者中AKI发病率较高，包括非危重症儿童。AKI与发病率和死亡率显著增加相关。
