Guarino Stefano, Rivetti Giulio, Di Sessa Anna, De Lucia Maeva, Palma Pier Luigi, Miraglia Del Giudice Emanuele, Polito Cesare, Marzuillo Pierluigi
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.
Children (Basel). 2022 Jun 16;9(6):899. doi: 10.3390/children9060899.
At type 1 diabetes mellitus (T1DM) onset, acute kidney injury (AKI) is very common. To diagnose AKI, the availability of a baseline serum creatinine (bSCr) is pivotal. However, in most hospitalized children the bSCr is unknown. We aimed to test whether the bSCr estimated on the basis of height (ebSCr) could be a reliable surrogate for AKI diagnosis compared with the measured bSCr (mbSCr). As the mbSCr, we considered the creatinine measured 14 days after T1DM onset while ebSCr (mg/dL) = (k × height [cm])/120 mL/min/1.73 m2, where k = 0.55 for children and adolescent girls and k = 0.7 for adolescent boys. AKI was defined as serum creatinine values >1.5 times the baseline creatinine. Kappa statistics and the percentage of agreement in AKI classification by ebSCr−AKI versus mbSCr−AKI definition methods were calculated. Bland−Altman plots were used to show the agreement between the creatinine ratio (highest/baseline creatinine; HC/BC) calculated with mbSCr and ebSCr. The number of 163 patients with T1DM onset were included. On the basis of mbSCr, 66/163 (40.5%) presented AKI while, on the basis of ebSCr, 50/163 (30.7%) accomplished AKI definition. ebSCr showed good correlation with mbSCr using both the Spearman test (rho = 0.67; p < 0.001) and regression analysis (r = 0.68; p < 0.001). Moreover, at the Bland−Altman plots, the bias of the highest/baseline creatinine ratio calculated on the basis of the mbSCr compared to ebSCr was minimal (bias = −0.08 mg/dL; 95% limits of agreement = −0.23/0.39). AKI determined using ebSCr showed 90% agreement with AKI determined using mbSCr (kappa = 0.66; p < 0.001). Finally, we compared the area under a receiver−operating characteristic curve (AUROC) of HC/BC ratio calculated on the basis of ebSCr with AUROC of the gold standard HC/BC ratio calculated on the basis of mbSCr. As expected, the gold standard had an AUROC = 1.00 with a 95% confidence interval (CI) between 0.98 and 1.00, p < 0.001. The HC/BC ratio calculated on the basis of ebSCr also had significant AUROC (AUROC = 0.94; 95% CI: 0.90−0.97; p < 0.001). The comparison of the two ROC curves showed a p < 0.001. In conclusion, when mbSCr is unknown in patients with T1DM onset, the ebSCr calculated on the basis of height could be an alternative to orientate clinicians toward AKI diagnosis.
在1型糖尿病（T1DM）发病时，急性肾损伤（AKI）非常常见。对于诊断AKI而言，基线血清肌酐（bSCr）的可用性至关重要。然而，在大多数住院儿童中，bSCr并不明确。我们旨在测试基于身高估算的bSCr（ebSCr）与测量的bSCr（mbSCr）相比，是否能成为诊断AKI的可靠替代指标。作为mbSCr，我们采用T1DM发病14天后测量的肌酐值，而ebSCr（mg/dL）=（k×身高[cm]）/120 mL/min/1.73 m²，其中儿童和青春期女孩的k = 0.55，青春期男孩的k = 0.7。AKI定义为血清肌酐值>基线肌酐的1.5倍。计算了Kappa统计量以及ebSCr - AKI与mbSCr - AKI定义方法在AKI分类中的一致性百分比。采用Bland - Altman图展示用mbSCr和ebSCr计算的肌酐比值（最高/基线肌酐；HC/BC）之间的一致性。纳入了163例T1DM发病患者。基于mbSCr，66/（163例）（40.5%）出现AKI，而基于ebSCr，50/（163例）（30.7%）符合AKI定义。使用Spearman检验（rho = 0.67；p < 0.001）和回归分析（r = 0.68；p < 0.001），ebSCr与mbSCr均显示出良好的相关性。此外，在Bland - Altman图中，基于mbSCr与ebSCr计算的最高/基线肌酐比值的偏差极小（偏差 = -0.08 mg/dL；95%一致性界限 = -0.23/0.39）。使用ebSCr确定的AKI与使用mbSCr确定的AKI显示出90%的一致性（kappa = 0.66；p < 0.001）。最后，我们比较了基于ebSCr计算的HC/BC比值的受试者工作特征曲线下面积（AUROC）与基于mbSCr计算的金标准HC/BC比值的AUROC。正如预期的那样，金标准的AUROC = 1.00，95%置信区间（CI）在0.98至1.00之间，p < 0.001。基于ebSCr计算的HC/BC比值也具有显著的AUROC（AUROC = 0.94；95% CI：0.90 - 0.97；p < 0.001）。两条ROC曲线的比较显示p < 0.001。总之，当T1DM发病患者的mbSCr未知时，基于身高计算的ebSCr可作为一种替代方法，帮助临床医生进行AKI诊断。
