Van den Eynde Jef, Rotbi Hajar, Gewillig Marc, Kutty Shelby, Allegaert Karel, Mekahli Djalila
Helen B. Taussig Heart Center, The Johns Hopkins Hospital and School of Medicine, Baltimore, MD, United States.
Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium.
Front Pediatr. 2021 Sep 3;9:733744. doi: 10.3389/fped.2021.733744. eCollection 2021.
Cardiac surgery-associated acute kidney injury (CS-AKI) is associated with increased morbidity and mortality in both adults and children. This study aimed to investigate the in-hospital outcomes of CS-AKI in the pediatric population. PubMed/MEDLINE, Embase, Scopus, and reference lists of relevant articles were searched for studies published by August 2020. Random-effects meta-analysis was performed, comparing in-hospital outcomes between patients who developed CS-AKI and those who did not. Fifty-eight publications between 2008 and 2020 consisting of 18,334 participants (AKI: 5,780; no AKI: 12,554) were included. Higher rates of in-hospital mortality (odds ratio [OR] 7.22, 95% confidence interval [CI] 5.27-9.88), need for renal replacement therapy (RRT) (OR 18.8, 95% CI 11.7-30.5), and cardiac arrhythmias (OR 2.67, 95% 1.86-4.80) were observed in patients with CS-AKI. Furthermore, patients with AKI had longer ventilation times (mean difference [MD] 1.76 days, 95% CI 1.05-2.47), pediatric intensive care unit (PICU) length of stay (MD 3.31, 95% CI 2.52-4.10), and hospital length of stay (MD 5.00, 95% CI 3.34-6.67). CS-AKI in the pediatric population is associated with a higher risk of mortality, cardiac arrhythmias and need for RRT, as well as greater mechanical ventilation time, PICU and hospital length of stay. These results might help improve the clinical care protocols prior to cardiac surgery to minimize the disease burden of CS-AKI in children. Furthermore, etiology-specific approaches to AKI are warranted, as outcomes are likely impacted by the underlying cause.
心脏手术相关急性肾损伤（CS-AKI）与成人和儿童的发病率及死亡率增加相关。本研究旨在调查儿科人群中CS-AKI的院内结局。检索了PubMed/MEDLINE、Embase、Scopus以及相关文章的参考文献列表，以查找2020年8月前发表的研究。进行随机效应荟萃分析，比较发生CS-AKI的患者与未发生CS-AKI的患者的院内结局。纳入了2008年至2020年间的58篇出版物，共18334名参与者（急性肾损伤：5780例；无急性肾损伤：12554例）。观察到CS-AKI患者的院内死亡率（比值比[OR] 7.22，95%置信区间[CI] 5.27 - 9.88）、肾脏替代治疗（RRT）需求（OR 18.8，95% CI 11.7 - 30.5）以及心律失常（OR 2.67，95% 1.86 - 4.80）发生率更高。此外，急性肾损伤患者的机械通气时间更长（平均差[MD] 1.76天，95% CI 1.05 - 2.47）、儿科重症监护病房（PICU）住院时间更长（MD 3.31，95% CI 2.52 - 4.10）以及住院时间更长（MD 5.00，95% CI 3.34 - 6.67）。儿科人群中的CS-AKI与更高的死亡风险、心律失常及RRT需求相关，同时机械通气时间、PICU住院时间和住院时间更长。这些结果可能有助于改善心脏手术前的临床护理方案，以尽量减少儿童CS-AKI的疾病负担。此外，鉴于结局可能受潜在病因影响，针对急性肾损伤的病因特异性方法是必要的。
