利用肾绞痛指数预测儿科重症监护病房的严重急性肾损伤。
Prediction of Severe Acute Kidney Injury using Renal Angina Index in a Pediatric Intensive Care Unit.
机构信息
Department of Pediatrics, Chacha Nehru Bal Chikitsalaya, Geeta Colony, Delhi, India.
Department of Pediatrics, Chacha Nehru Bal Chikitsalaya, Geeta Colony, Delhi, India. Correspondence to: Dr Kirtisudha Mishra, Department of Pediatrics, Chacha Nehru Bal Chikitsalaya, Geeta Colony, Delhi 110 031, India.
出版信息
Indian Pediatr. 2019 Aug 15;56(8):647-652.
OBJECTIVE
To determine the proportion of children in a pediatric intensive care unit with a positive Day 0 Renal angina index who develop severe acute kidney injury (AKI) on Day 3; and to compare the predictive ability of the index with that of individual markers of renal injury, for the development of severe acute kidney injury.
DESIGN
Observational study.
SETTING
Pediatric intensive care unit of a tertiary-care hospital.
PARTICIPANTS
Consecutive children, 1 month to 12 years, admitted in Level 3 pediatric intensive care unit for a minimum of 8 hours, having weight and intake-output records, were eligible. Children known to have chronic kidney disease or already in stage 2/3 acute kidney injury/dialysis were excluded.
PROCEDURE
Day 0 Renal angina index was calculated from the product of Risk Group score (Pediatric intensive care admission/Ventilation and inotropy) and Renal Injury score (fluid overload over previous 8 hours or the % fall in estimated creatinine clearance from baseline). Renal angina index ³8 was considered positive.
MAIN OUTCOME MEASURE
The proportion of children with positive Day 0 Renal angina index who develop severe AKI (Kidney Disease Improving Global Outcomes (KDIGO) ≥ Stage 2) on Day 3.
RESULTS
Of 162 enrolled children (median (IQR) age 10.5 (3,39) months), 86 (53%) had positive Renal angina index. On Day 3, a higher proportion of children with positive index developed severe AKI, compared to negative group (RR 95.5; 95% CI 21.7,420.5; P<0.001). Day 0 positive Renal angina index had a sensitivity, specificity, positive predictive value and negative predictive value of 96.9%, 75.5%, 72% and 97.4% respectively, for predicting severe AKI on Day 3. The Receiver Operating Characteristic curve of Day 0 renal angina scores showed AUC of 0.90 (95% CI 0.85, 0.95), better than the AUC obtained from either Day 0 serum creatinine or Day 0 percent fall in estimated creatinine clearance from baseline.
CONCLUSIONS
Day 0 Renal angina index positivity is a promising tool to identify critically ill children with impending severe AKI.
目的
确定儿科重症监护病房中 Day0 肾绞痛指数阳性的患儿在 Day3 时发生严重急性肾损伤（AKI）的比例；并比较该指数与单个肾损伤标志物对严重急性肾损伤的预测能力。
设计
观察性研究。
地点
三级医院儿科重症监护病房。
参与者
连续入选至少 8 小时入住 3 级儿科重症监护病房、有体重和出入量记录的 1 个月至 12 岁儿童。排除已知患有慢性肾脏病或已处于 2/3 期急性肾损伤/透析的儿童。
程序
Day0 肾绞痛指数通过风险组评分（儿科重症监护病房入院/通气和正性肌力）与肾损伤评分（前 8 小时液体超负荷或估计肌酐清除率从基线下降的%）的乘积计算。Renal angina index³8 被认为是阳性的。
主要观察指标
Day0 肾绞痛指数阳性患儿在 Day3 时发生严重 AKI（KDIGO≥2 期）的比例。
结果
共纳入 162 例患儿（中位数（IQR）年龄 10.5（3，39）个月），86 例（53%）肾绞痛指数阳性。与阴性组相比，阳性指数组 Day3 时发生严重 AKI 的患儿比例更高（RR 95.5；95%CI 21.7，420.5；P<0.001）。Day0 阳性肾绞痛指数预测 Day3 严重 AKI 的敏感性、特异性、阳性预测值和阴性预测值分别为 96.9%、75.5%、72%和 97.4%。Day0 肾绞痛评分的受试者工作特征曲线显示 AUC 为 0.90（95%CI 0.85，0.95），优于 Day0 血清肌酐或 Day0 估计肌酐清除率基线下降的 AUC。
结论
Day0 肾绞痛指数阳性是识别即将发生严重 AKI 的危重症患儿的一种很有前途的工具。
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