Department of Pediatrics, Advocate Children's Hospital, Oak Lawn, Ill.
Division of Pediatric Cardiology, Department of Pediatrics, University of Colorado Denver, Anschutz Medical Campus, Children's Hospital Colorado, Aurora, Colo.
J Thorac Cardiovasc Surg. 2019 Jun;157(6):2444-2451. doi: 10.1016/j.jtcvs.2018.12.076. Epub 2019 Jan 11.
A standardized assessment of response to furosemide is predictive of acute kidney injury progression in adults, but a paucity of data exists in pediatric patients. We evaluate furosemide responsiveness in a multicenter cohort of pediatric patients after cardiac surgery.
Children who underwent cardiac surgery with a Society of Thoracic Surgeons-European Association for Cardiothoracic Surgery score of 3 or greater were retrospectively identified. The first dose of furosemide after surgery was recorded, and hourly urine output for 6 hours was recorded after the index dose. Urine flow rate calculated as urine output per hour was used to predict development of acute kidney injury.
A total of 166 patients from 4 institutions (median age, 6.3 months; interquartile range, 0.4-27.7) were included. Acute kidney injury occurred in 54 patients (33%). Compared with those without acute kidney injury, the 2- and 6-hour urine flow rates were significantly lower in patients in whom acute kidney injury developed: 2.9 (0.9-6.5) versus 5.0 (2.5-9.0) mL/kg/h for 2-hour urine flow rate, P = .004, and 2.4 (1.2-4.0) versus 4.0 (2.3-5.9) mL/kg/h for 6-hour flow rate, P = .001. In multivariable regression analysis, 2-hour (odds ratio, 1.2, P = .002) and 6-hour (odds ratio, 1.40, P < .001) urine flow rates were independently associated with acute kidney injury development. Lower urine flow rate at both 2 and 6 hours was also independently associated with longer hospital length of stay.
Lower urine flow rate after furosemide administration, when evaluated in a heterogeneous cohort of children from multiple institutions after pediatric cardiac surgery, was independently associated with subsequent acute kidney injury and longer length of stay. Future prospective studies are needed to validate furosemide responsiveness as a predictor of acute kidney injury.
对呋塞米反应的标准化评估可预测成人急性肾损伤的进展，但儿科患者的数据很少。我们评估了接受心脏手术后的多中心儿科患者群体中的呋塞米反应性。
回顾性确定接受 Society of Thoracic Surgeons-European Association for Cardiothoracic Surgery 评分≥3 分的心脏手术后患者。记录手术后的首剂呋塞米，并在指数剂量后 6 小时内记录每小时尿量。将每小时尿量计算为尿量/小时，用于预测急性肾损伤的发生。
共有来自 4 个机构的 166 名患者（中位数年龄为 6.3 个月；四分位距为 0.4-27.7）被纳入。54 名患者（33%）发生急性肾损伤。与未发生急性肾损伤的患者相比，发生急性肾损伤的患者的 2 小时和 6 小时尿量明显较低：2 小时尿量分别为 2.9（0.9-6.5）和 5.0（2.5-9.0）mL/kg/h，P=0.004，6 小时尿量分别为 2.4（1.2-4.0）和 4.0（2.3-5.9）mL/kg/h，P=0.001。多变量回归分析显示，2 小时（比值比，1.2，P=0.002）和 6 小时（比值比，1.40，P<0.001）尿量与急性肾损伤的发生独立相关。2 小时和 6 小时的较低尿量也与更长的住院时间独立相关。
在接受心脏手术后来自多个机构的异质儿科患者群体中，评估呋塞米给药后的尿量较低与随后的急性肾损伤和更长的住院时间独立相关。需要进一步的前瞻性研究来验证呋塞米反应性作为急性肾损伤预测因子的有效性。
