Pediatric Intensive Care Unit, Children's Hospital of Soochow University, Suzhou, China.
Department of Epidemiology, Children's Hospital of Soochow University, Suzhou, China.
BMC Nephrol. 2020 Aug 20;21(1):358. doi: 10.1186/s12882-020-02023-0.
Acute kidney injury (AKI) is independently related to the adverse outcome of septic shock, but it lacks effective early predictors. Renal anginal index (RAI) was used to predict subsequent severe AKI (AKIs) in critically ill patients. The application of RAI in children with septic shock has not been reported. This study aims to evaluate the efficacy of early RAI in predicting subsequent AKIs within 3 days after PICU admission in children with septic shock by comparing with early fluid overload (FO) and early creatinine elevation.
Sixty-six children admitted to PICU aged 1 month to 16 years old, with septic shock from January 2016 to December 2019 were analyzed retrospectively. According to the 2012 Kidney Disease Improving Global outcomes (KDIGO) criteria, AKIs was defined by the KDIGO stage ≥2 within 3 days after PICU admission. Early RAI positive (RAI+) was defined as RAI ≥ 8 within 12 h of PICU admission. Any elevation of serum creatinine (SCr) over baseline within 12 h after PICU admission was denoted as "Early SCr > base". Early FO positive (FO+) was defined as FO > 10% within 24 h of PICU admission.
Of 66 eligible cases, the ratio of early RAI+, early SCr > base, early FO+ was 57.57, 59.09 and 16.67% respectively. The incidence of AKIs in early RAI+ group (78.94%) was higher than that in early RAI- group (21.42%) (p = 0.04), and there was no significant difference compared with the early FO+ group (71.79%) and early SCr > base group (81.82%) (P > 0.05). After adjustment for confounders, early RAI+ was independently associated with the occurrence of AKIs within 3 days (OR 10.04, 95%CI 2.39-42.21, p < 0.01). The value of early RAI+ (AUC = 0.78) to identify patients at high risk of AKIs was superior to that of early SCr > base (AUC = 0.70) and early FO+ (AUC = 0.58). A combination of serum lactate with early RAI+ improved the predictive performance for assessing AKIs (AUC = 0.83).
Early RAI could be used as a more convenient and effective index to predict the risk of AKIs in children with septic shock within 3 days. Early RAI+ combined with serum lactate improved the predictive performance for assessing AKIs.
急性肾损伤（AKI）与脓毒性休克的不良结局独立相关，但缺乏有效的早期预测指标。肾绞痛指数（RAI）曾被用于预测危重症患者随后发生的严重 AKI（AKIs）。RAI 在脓毒性休克儿童中的应用尚未见报道。本研究旨在通过比较早期液体过载（FO）和早期肌酐升高，评估 RAI 在预测脓毒性休克儿童重症监护病房（PICU）入院后 3 天内发生 AKIs 的效果。
回顾性分析 2016 年 1 月至 2019 年 12 月间因脓毒性休克入住 PICU 的 1 个月至 16 岁儿童 66 例。根据 2012 年肾脏病：改善全球预后组织（KDIGO）标准，将 PICU 入院后 3 天内发生的 KDIGO 分期≥2 期 AKI 定义为 AKIs。早期 RAI 阳性（RAI+）定义为 PICU 入院后 12 小时内 RAI≥8。PICU 入院后 12 小时内血清肌酐（SCr）基线任何升高定义为“早期 SCr＞基础值”。早期 FO 阳性（FO+）定义为 PICU 入院后 24 小时内 FO＞10%。
66 例符合条件的病例中，早期 RAI+、早期 SCr＞基础值和早期 FO+的比例分别为 57.57%、59.09%和 16.67%。早期 RAI+组（78.94%）AKIs 的发生率高于早期 RAI-组（21.42%）（p=0.04），但与早期 FO+组（71.79%）和早期 SCr＞基础值组（81.82%）无显著差异（P＞0.05）。经混杂因素调整后，早期 RAI+与 3 天内 AKIs 的发生独立相关（OR 10.04，95%CI 2.39-42.21，p＜0.01）。早期 RAI+（AUC=0.78）识别 AKIs 高危患者的价值优于早期 SCr＞基础值（AUC=0.70）和早期 FO+（AUC=0.58）。血清乳酸与早期 RAI+联合可提高 AKIs 评估的预测性能（AUC=0.83）。
早期 RAI 可作为预测脓毒性休克儿童 3 天内 AKIs 风险的更便捷、有效的指标。早期 RAI+联合血清乳酸可提高 AKIs 评估的预测性能。
