Marzuillo Pierluigi, Coppola Crescenzo, Caiazzo Roberta, Macchini Giulia, Di Sessa Anna, Guarino Stefano, Esposito Francesco, Miraglia Del Giudice Emanuele, Tipo Vincenzo
Department of Woman, Child and of General and Specialized Surgery, Università Degli Studi Della Campania "Luigi Vanvitelli", Via Luigi De Crecchio 2, 80138 Naples, Italy.
Pediatric Emergency Department, A.O.R.N Santobono-Pausilipon, Via Mario Fiore 6, 80129 Naples, Italy.
Children (Basel). 2022 Apr 27;9(5):620. doi: 10.3390/children9050620.
We hypothesized that-as in other common pediatric conditions-acute appendicitis (AA) could be complicated by acute kidney injury (AKI). We aimed to investigate the prevalence of, and the factors associated with AKI in a cohort of patients with AA. We retrospectively collected data of 122 children (63.9% of male gender; mean age 8.6 ± 2.9 years; range: 2.2-13.9 years) hospitalized for AA. AKI was defined according to the Kidney Disease/Improving Global Outcomes creatinine criteria. We considered a basal serum creatinine value as the value of creatinine estimated with the Hoste (age) equation, assuming that the basal estimated glomerular filtration rate (eGFR) was 120 mL/min/1.73 m. Explorative univariate logistic regression analysis was used to explore the associations with AKI. Out of 122 patients, nine (7.4%) presented with AKI. One patient had stage two AKI and the remaining had stage one AKI. The maximum AKI stage was found at admission. The patients with AKI showed a higher prevalence of fever ≥ 38.5 °C ( = 0.02), vomiting ( = 0.03), ≥5% dehydration ( = 0.03), and higher levels of both C-reactive protein (CRP) ( = 0.002) and neutrophils ( = 0.03) compared with patients without AKI. Because all patients with AKI also presented with vomiting, an Odds Ratio (OR) for the vomiting was not calculable. The exploratory univariate logistic regression analysis confirmed that fever ≥ 38.5 °C (OR = 5.0; 95% CI: 1.2/21.5; = 0.03), ≥5% dehydration (OR = 8.4; 95% CI: 1.1/69.6; = 0.04), CRP (OR = 1.1; 95% CI: 1.05/1.2; = 0.01), and neutrophil levels (OR = 1.1; 95% CI: 1.01/1.3; = 0.04) were all predictive factors of AKI. AKI can occur in 7.4% of patients with AA. Particular attention should be paid to the kidney health of patients with AA especially in the presence of vomiting, ≥5% dehydration, fever ≥ 38.5 °C, and high CRP and neutrophils levels.
我们推测，如同其他常见的儿科疾病一样，急性阑尾炎（AA）可能会并发急性肾损伤（AKI）。我们旨在调查一组AA患者中AKI的患病率及其相关因素。我们回顾性收集了122名因AA住院的儿童的数据（男性占63.9%；平均年龄8.6±2.9岁；范围：2.2 - 13.9岁）。AKI根据肾脏病改善全球预后组织的肌酐标准进行定义。我们将基础血清肌酐值视为用霍斯特（年龄）方程估算的肌酐值，假设基础估算肾小球滤过率（eGFR）为120 mL/min/1.73 m²。采用探索性单因素逻辑回归分析来探究与AKI的关联。在122例患者中，9例（7.4%）出现了AKI。1例患者为2期AKI，其余为1期AKI。AKI的最高分期在入院时被发现。与未发生AKI的患者相比，发生AKI的患者发热≥38.5℃（P = 0.02）、呕吐（P = 0.03）、脱水≥5%（P = 0.03）以及C反应蛋白（CRP）（P = 0.002）和中性粒细胞水平（P = 0.03）更高。由于所有发生AKI的患者均伴有呕吐，因此呕吐的比值比（OR）无法计算。探索性单因素逻辑回归分析证实，发热≥38.5℃（OR = 5.0；95%CI：1.2/21.5；P = 0.03）、脱水≥5%（OR = 8.4；95%CI：1.1/69.6；P = 0.04）、CRP（OR = 1.1；95%CI：1.05/1.2；P = 0.01）以及中性粒细胞水平（OR = 1.1；95%CI：1.01/1.3；P = 0.04）均为AKI的预测因素。7.4%的AA患者可能发生AKI。应特别关注AA患者的肾脏健康，尤其是在出现呕吐、脱水≥5%、发热≥38.5℃以及CRP和中性粒细胞水平升高的情况下。
