Department of Anesthesiology and Critical Care, Perelman School of Medicine, The University of Pennsylvania and Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
Department of Pediatrics, Emory School of Medicine, Atlanta, Georgia.
Pediatrics. 2022 Jan 1;149(1 Suppl 1):S66-S73. doi: 10.1542/peds.2021-052888J.
Renal dysfunction is associated with poor outcomes in critically ill children.
To evaluate the current evidence for criteria defining renal dysfunction in critically ill children and association with adverse outcomes. To develop contemporary consensus criteria for renal dysfunction in critically ill children.
PubMed and Embase were searched from January 1992 to January 2020.
Included studies evaluated critically ill children with renal dysfunction, performance characteristics of assessment tools for renal dysfunction, and outcomes related to mortality, functional status, or organ-specific or other patient-centered outcomes. Studies with adults or premature infants (≤36 weeks' gestational age), animal studies, reviews, case series, and studies not published in English with inability to determine eligibility criteria were excluded.
Data were extracted from included studies into a standard data extraction form by task force members.
The systematic review supported the following criteria for renal dysfunction: (1) urine output <0.5 mL/kg per hour for ≥6 hours and serum creatinine increase of 1.5 to 1.9 times baseline or ≥0.3 mg/dL, or (2) urine output <0.5 mL/kg per hour for ≥12 hours, or (3) serum creatinine increase ≥2 times baseline, or (4) estimated glomerular filtration rate <35 mL/minute/1.73 m2, or (5) initiation of renal replacement therapy, or (6) fluid overload ≥20%. Data also support criteria for persistent renal dysfunction and for high risk of renal dysfunction.
All included studies were observational and many were retrospective.
We present consensus criteria for renal dysfunction in critically ill children.
肾功能障碍与危重症患儿的不良预后相关。
评估目前用于定义危重症儿童肾功能障碍的标准，并评估其与不良预后的关系。制定用于定义危重症儿童肾功能障碍的当代共识标准。
从 1992 年 1 月至 2020 年 1 月，对 PubMed 和 Embase 进行了检索。
纳入的研究评估了肾功能障碍的危重症儿童、肾功能障碍评估工具的性能特征，以及与死亡率、功能状态或器官特异性或其他以患者为中心的结局相关的结局。排除了成人或早产儿（≤36 周胎龄）、动物研究、综述、病例系列以及未以英文发表且无法确定入选标准的研究。
由工作组成员将纳入研究中的数据提取到标准数据提取表中。
系统评价支持以下肾功能障碍标准：（1）尿量<0.5 mL/kg/小时持续 6 小时以上且血清肌酐升高 1.5 至 1.9 倍基线或≥0.3 mg/dL，或（2）尿量<0.5 mL/kg/小时持续 12 小时以上，或（3）血清肌酐升高≥2 倍基线，或（4）估算肾小球滤过率<35 mL/min/1.73 m2，或（5）开始肾脏替代治疗，或（6）液体超负荷≥20%。数据还支持持续肾功能障碍和肾功能障碍高危的标准。
所有纳入的研究均为观察性研究，且许多为回顾性研究。
我们提出了危重症儿童肾功能障碍的共识标准。
