Nephrology, Dialysis and Transplant Unit, Department of Woman's and Child's Health, University Hospital of Padova, Padova, Italy.
Pediatric Intensive Care Unit, Department of Woman's and Child's Health, University Hospital of Padova, Padova, Italy.
Blood Purif. 2020;49(1-2):1-7. doi: 10.1159/000502081. Epub 2019 Aug 5.
Children admitted to paediatric intensive care unit (PICU) are at risk of acute kidney injury (AKI). However, few paediatric studies have focused on the identification of factors potentially associated with the development of this condition. The aim of our study was to assess the incidence rate of AKI, identify risk factors, and evaluate clinical outcome in a large sample of critically ill children.
This retrospective observational study was conducted including patients admitted to our PICU from January 2014 to December 2016. AKI was defined according to Kidney Disease: Improving Global Outcome criteria.
A total of 222 PICU patients out of 811 (27%) had AKI (stage I 39%, stage II 24%, stage III 37%). The most common PICU admission diagnoses in AKI cases were heart disease (38.6%), respiratory failure (16.8%) and postsurgical non-cardiac patients (11%). Hypoxic-ischaemic was the most frequent cause of AKI. Significant risk factors for AKI following multivariate analysis were age >2 months (OR 2.43; 95% CI 1.03-7.87; p = 0.05), serum creatinine at admission >44 µmol/L (OR 2.23; 95% CI 1.26-3.94; p = 0.006), presence of comorbidities (OR 1.84; 95% CI 1.03-3.30; p = 0.04), use of inotropes (OR 2.56; 95% CI 1.23-5.35; p= 0.012) and diuretics (OR 2.78; 95% CI 1.49-5.19; p = 0.001), exposure to nephrotoxic drugs (OR 1.66; 95% CI 1.01-2.91; p= 0.04), multiple organ dysfunction syndrome (OR 2.68; 95% CI 1.43-5.01; p = 0.002), and coagulopathy (OR 1.89; 95% CI 1.05-3.38, p = 0.03). AKI was associated with a significant longer PICU stay (median LOS of 8 days, interquartile range [IQR] 3-16, versus 4 days, IQR 2-8, in non-AKI patients; p < 0.001). The mortality rate resulted tenfold higher in AKI than non-AKI patients (12.6 vs. 1.2%; p < 0.001).
The incidence of AKI in critically ill children is high, with an associated increased length of stay and risk of mortality. In the PICU setting, risk factors of AKI are multiple and mainly associated with illness severity.
入住儿科重症监护病房（PICU）的儿童有发生急性肾损伤（AKI）的风险。然而，很少有儿科研究关注与该疾病发展相关的潜在因素。我们的研究旨在评估大样本危重儿童 AKI 的发病率、识别危险因素和评估临床结局。
本回顾性观察性研究纳入了 2014 年 1 月至 2016 年 12 月期间入住我院 PICU 的患者。AKI 根据肾脏病：改善全球结局标准进行定义。
222 名 PICU 患者（27%）患有 AKI（I 期 39%、II 期 24%、III 期 37%）。AKI 病例中最常见的 PICU 入院诊断为心脏病（38.6%）、呼吸衰竭（16.8%）和非心脏手术后患者（11%）。缺氧缺血是 AKI 的最常见原因。多变量分析显示 AKI 的显著危险因素包括>2 个月龄（OR 2.43；95%CI 1.03-7.87；p=0.05）、入院时血清肌酐>44 μmol/L（OR 2.23；95%CI 1.26-3.94；p=0.006）、合并症（OR 1.84；95%CI 1.03-3.30；p=0.04）、使用正性肌力药物（OR 2.56；95%CI 1.23-5.35；p=0.012）和利尿剂（OR 2.78；95%CI 1.49-5.19；p=0.001）、接触肾毒性药物（OR 1.66；95%CI 1.01-2.91；p=0.04）、多器官功能障碍综合征（OR 2.68；95%CI 1.43-5.01；p=0.002）和凝血障碍（OR 1.89；95%CI 1.05-3.38，p=0.03）。AKI 与 ICU 住院时间显著延长相关（AKI 患者的中位 ICU 住院时间为 8 天，四分位距 [IQR] 3-16，而非 AKI 患者为 4 天，IQR 2-8；p<0.001）。AKI 患者的死亡率是无 AKI 患者的 10 倍（12.6% vs. 1.2%；p<0.001）。
危重症儿童 AKI 的发病率较高，与住院时间延长和死亡风险增加有关。在 PICU 环境中，AKI 的危险因素是多方面的，主要与疾病严重程度相关。
