新生儿重症监护病房出院时急性肾损伤的记录和肾脏病学咨询的作用。
Documentation of acute kidney injury at discharge from the neonatal intensive care unit and role of nephrology consultation.
机构信息
Department of Pediatrics, Division of Nephrology, Indiana University School of Medicine, Indianapolis, IN, USA.
Department of Pediatrics, Division of Neonatology, Indiana University School of Medicine, Indianapolis, IN, USA.
出版信息
J Perinatol. 2022 Jul;42(7):930-936. doi: 10.1038/s41372-022-01424-3. Epub 2022 Jun 8.
OBJECTIVE
To investigate whether NICU discharge summaries documented neonatal AKI and estimate if nephrology consultation mediated this association.
STUDY DESIGN
Secondary analysis of AWAKEN multicenter retrospective cohort.
EXPOSURES
AKI severity and diagnostic criteria.
OUTCOME
AKI documentation on NICU discharge summaries using multivariable logistic regression to estimate associations and test for causal mediation.
RESULTS
Among 605 neonates with AKI, 13% had documented AKI. Those with documented AKI were more likely to have severe AKI (70.5% vs. 51%, p < 0.001) and SCr-only AKI (76.9% vs. 50.1%, p = 0.04). Nephrology consultation mediated 78.0% (95% CL 46.5-109.4%) of the total effect of AKI severity and 82.8% (95% CL 70.3-95.3%) of the total effect of AKI diagnostic criteria on documentation.
CONCLUSION
We report a low prevalence of AKI documentation at NICU discharge. AKI severity and SCr-only AKI increased odds of AKI documentation. Nephrology consultation mediated the associations of AKI severity and diagnostic criteria with documentation.
目的
调查新生儿重症监护病房（NICU）出院小结中是否记录了新生儿急性肾损伤（AKI），并评估肾脏病学咨询是否影响了这一关联。
研究设计
AWAKEN 多中心回顾性队列的二次分析。
暴露因素
AKI 严重程度和诊断标准。
结局
使用多变量逻辑回归分析 NICU 出院小结中 AKI 的记录情况，以评估关联并检验因果中介作用。
结果
在 605 例 AKI 患儿中，有 13%的患儿记录了 AKI。与未记录 AKI 的患儿相比，记录 AKI 的患儿更有可能发生严重 AKI（70.5%比 51%，p<0.001）和仅血肌酐升高的 AKI（76.9%比 50.1%，p=0.04）。肾脏病学咨询解释了 AKI 严重程度（95%置信区间为 46.5-109.4%）和 AKI 诊断标准（95%置信区间为 70.3-95.3%）对记录的总效应的 78.0%和 82.8%。
结论
我们报告了 NICU 出院时 AKI 记录的低发生率。AKI 严重程度和仅血肌酐升高的 AKI 增加了 AKI 记录的可能性。肾脏病学咨询解释了 AKI 严重程度和诊断标准与记录之间的关联。
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