Pediatric Intensive Care Unit, King's College Hospital NHS Foundation Trust, London, United Kingdom.
Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, United Kingdom.
Crit Care Med. 2020 Dec;48(12):1809-1818. doi: 10.1097/CCM.0000000000004662.
To study the prevalence, evolution, and clinical factors associated with acute kidney injury in children admitted to PICUs with pediatric inflammatory multisystem syndrome temporally associated with severe acute respiratory syndrome coronavirus-2.
Multicenter observational study.
Fifteen PICUs across the United Kingdom.
Patients admitted to United Kingdom PICUs with pediatric inflammatory multisystem syndrome temporally associated with severe acute respiratory syndrome coronavirus-2 between March 14, 2020, and May 20, 2020.
None.
Deidentified data collected as part of routine clinical care were analyzed. All children were diagnosed and staged for acute kidney injury based on the level of serum creatinine above the upper limit of reference interval values according to published guidance. Severe acute kidney injury was defined as stage 2/3 acute kidney injury. Uni- and multivariable analyses were performed to study the association between demographic data, clinical features, markers of inflammation and cardiac injury, and severe acute kidney injury. Over the study period, 116 patients with pediatric inflammatory multisystem syndrome temporally associated with severe acute respiratory syndrome coronavirus-2 were admitted to 15 United Kingdom PICUs. Any-stage acute kidney injury occurred in 48 of 116 patients (41.4%) and severe acute kidney injury in 32 of 116 (27.6%) patients, which was mostly evident at admission (24/32, 75%). In univariable analysis, body mass index, hyperferritinemia, high C-reactive protein, Pediatric Index of Mortality 3 score, vasoactive medication, and invasive mechanical ventilation were associated with severe acute kidney injury. In multivariable logistic regression, hyperferritinemia was associated with severe acute kidney injury (compared with nonsevere acute kidney injury; adjusted odds ratio 1.04; 95% CI, 1.01-1.08; p = 0.04). Severe acute kidney injury was associated with longer PICU stay (median 5 days [interquartile range, 4-7 d] vs 3 days [interquartile range, 1.5-5 d]; p < 0.001) and increased duration of invasive mechanical ventilation (median 4 days [interquartile range, 2-6 d] vs 2 days [interquartile range, 1-3 d]; p = 0.04).
Severe acute kidney injury occurred in just over a quarter of children admitted to United Kingdom PICUs with pediatric inflammatory multisystem syndrome temporally associated with severe acute respiratory syndrome coronavirus-2. Hyperferritinemia was significantly associated with severe acute kidney injury. Severe acute kidney injury was associated with increased duration of stay and ventilation. Although short-term outcomes for acute kidney injury in pediatric inflammatory multisystem syndrome temporally associated with severe acute respiratory syndrome coronavirus-2 appear good, long-term outcomes are unknown.
研究与严重急性呼吸综合征冠状病毒 2 相关的儿科炎症性多系统综合征患儿入住儿科重症监护病房（PICU）时急性肾损伤的流行情况、演变和相关临床因素。
多中心观察性研究。
英国的 15 个 PICU。
2020 年 3 月 14 日至 2020 年 5 月 20 日期间因严重急性呼吸综合征冠状病毒 2 相关儿科炎症性多系统综合征而入住英国 PICU 的患者。
无。
对作为常规临床护理一部分收集的去识别数据进行了分析。所有儿童均根据发布的指南，根据血清肌酐水平高于参考区间值上限，按急性肾损伤水平进行诊断和分期。严重急性肾损伤定义为 2/3 期急性肾损伤。进行了单变量和多变量分析，以研究人口统计学数据、临床特征、炎症和心脏损伤标志物与严重急性肾损伤之间的关系。在研究期间，116 名因严重急性呼吸综合征冠状病毒 2 相关儿科炎症性多系统综合征而入住 15 家英国 PICU 的患儿中，有 48 名（41.4%）发生任何阶段的急性肾损伤，32 名（27.6%）发生严重急性肾损伤，其中大多数在入院时就出现（24/32，75%）。单变量分析显示，体重指数、高血清铁蛋白、高 C 反应蛋白、儿科死亡风险 3 评分、血管活性药物和有创机械通气与严重急性肾损伤相关。多变量逻辑回归显示，高血清铁蛋白与严重急性肾损伤相关（与非严重急性肾损伤相比；调整后的优势比 1.04；95%置信区间，1.01-1.08；p = 0.04）。严重急性肾损伤与 PICU 住院时间延长相关（中位数 5 天[四分位距，4-7 d] vs 3 天[四分位距，1.5-5 d]；p < 0.001），与有创机械通气时间延长相关（中位数 4 天[四分位距，2-6 d] vs 2 天[四分位距，1-3 d]；p = 0.04）。
因严重急性呼吸综合征冠状病毒 2 相关儿科炎症性多系统综合征而入住英国 PICU 的患儿中，有超过四分之一发生严重急性肾损伤。高血清铁蛋白与严重急性肾损伤显著相关。严重急性肾损伤与住院时间和通气时间延长有关。尽管严重急性呼吸综合征冠状病毒 2 相关儿科炎症性多系统综合征患儿的急性肾损伤短期预后似乎良好，但长期预后尚不清楚。
