Department of Pediatrics, Children's Hospital of Colorado, University of Colorado Anschutz Medical Campus, 13123 E 16th Ave, B100, Aurora, CO, 80045, USA.
Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA.
Pediatr Nephrol. 2023 Apr;38(4):1343-1353. doi: 10.1007/s00467-022-05708-w. Epub 2022 Aug 9.
Acute kidney injury (AKI) and fluid overload (FO) are associated with poor outcomes in children receiving extracorporeal membrane oxygenation (ECMO). Our objective is to evaluate the impact of AKI and FO on pediatric patients receiving ECMO for cardiac pathology.
We performed a secondary analysis of the six-center Kidney Interventions During Extracorporeal Membrane Oxygenation (KIDMO) database, including only children who underwent ECMO for cardiac pathology. AKI was defined using Kidney Disease: Improving Global Outcomes (KDIGO) creatinine criteria. FO was defined as < 10% (FO-) vs. ≥ 10% (FO +) and was evaluated at ECMO initiation, peak during ECMO, and ECMO discontinuation. Primary outcomes were mortality and length of stay (LOS).
Data from 191 patients were included. Non-survivors (56%) were more likely to be FO + than survivors at peak ECMO fluid status and ECMO discontinuation. There was a significant interaction between AKI and FO. In the presence of AKI, the adjusted odds of mortality for FO + was 4.79 times greater than FO- (95% CI: 1.52-15.12, p = 0.01). In the presence of FO + , the adjusted odds of mortality for AKI + was 2.7 times higher than AKI- [95%CI: 1.10-6.60; p = 0.03]. Peak FO + was associated with a 55% adjusted relative increase in LOS [95%CI: 1.07-2.26, p = 0.02].
The association of peak FO + with mortality is present only in the presence of AKI + . Similarly, AKI + is associated with mortality only in the presence of peak FO + . FO + was associated with LOS. Studies targeting fluid management have the potential to improve LOS and mortality outcomes. A higher resolution version of the Graphical abstract is available as Supplementary information.
急性肾损伤（AKI）和液体超负荷（FO）与接受体外膜氧合（ECMO）治疗的儿童预后不良相关。我们的目的是评估 AKI 和 FO 对因心脏疾病接受 ECMO 治疗的儿科患者的影响。
我们对六个中心的肾脏干预期间体外膜氧合（KIDMO）数据库进行了二次分析，仅纳入因心脏疾病接受 ECMO 治疗的儿童。AKI 采用肾脏病：改善全球预后（KDIGO）肌酐标准定义。FO 定义为 <10%（FO-）与≥10%（FO+），并在 ECMO 开始时、峰值时和 ECMO 停止时进行评估。主要结局为死亡率和住院时间（LOS）。
共纳入 191 例患者的数据。与幸存者相比，非幸存者（56%）在 ECMO 液量峰值时和 ECMO 停止时更有可能为 FO+。AKI 和 FO 之间存在显著的相互作用。在存在 AKI 的情况下，FO+的死亡调整优势比为 FO-的 4.79 倍（95%CI：1.52-15.12，p=0.01）。在存在 FO+的情况下，AKI+的死亡调整优势比为 AKI-的 2.7 倍[95%CI：1.10-6.60；p=0.03]。FO+峰值与 LOS 调整后相对增加 55%相关[95%CI：1.07-2.26，p=0.02]。
仅在存在 AKI+的情况下，FO+峰值与死亡率之间存在关联。同样，仅在存在 FO+峰值的情况下，AKI+与死亡率相关。FO+与 LOS 相关。针对液体管理的研究有可能改善 LOS 和死亡率结局。图形摘要的更高分辨率版本可作为补充信息提供。
