Pediatric Intensive Care Unit, Department of Pediatrics, Clinics Hospital of the State University of Campinas (UNICAMP), Campinas, SP, Brazil.
Department of Pediatrics, School of Medicine São Leopoldo Mandic, Campinas, SP, Brazil.
Pediatr Res. 2023 May;93(6):1694-1700. doi: 10.1038/s41390-022-02296-1. Epub 2022 Sep 8.
Renal resistive index (RRI) and renal pulsatility index (RPI) are Doppler-based variables proposed to assess renal perfusion at the bedside in critically ill patients. This study aimed to assess the accuracy of such variables to predict acute kidney injury (AKI) in mechanically ventilated children.
Consecutive children aged <14 years underwent kidney Doppler ultrasound examination within 24 h of invasive mechanical ventilation. Renal resistive index (RRI) and renal pulsatility index (RPI) were measured. The primary outcome was severe AKI (KDIGO stage 2 or 3) on day 3.
On day 3, 22 patients were classified as having AKI, of which 12 were severe. RRI could effectively predict severe AKI (area under the ROC curve [AUC] = 0.94) as well as RPI (AUC = 0.86). The optimal cut-off for RRI was 0.85 (sensitivity, 91.7%; specificity, 84.7%; PPV, 50.0%; and NPV, 98.4%). Similar results were obtained when the accuracy to predict AKI on day 5 was assessed. Significant correlations were observed between RRI and estimated glomerular filtration rate at enrollment (ρ = -0.495) and on day 3 (ρ = -0.467).
Renal Doppler ultrasound may be a promising tool to predict AKI in critically ill children under invasive mechanical ventilation.
Early recognition of acute kidney injury (AKI) is essential to promptly initiate supportive care aimed at restoring renal perfusion, which may prevent or attenuate acute tubular necrosis. Renal arterial Doppler-based parameters are rapid, noninvasive, and repeatable variables that may be promising for the prediction of AKI in children. To the best of our knowledge, this is the first study to evaluate the use of renal Doppler-based variables to predict AKI in critically ill children. The present study found that Doppler-based variables could accurately predict the occurrence of severe AKI and were correlated with urinary output and diuretic use.
肾阻力指数（RRI）和肾搏动指数（RPI）是基于多普勒的变量，旨在评估危重病患者床边的肾灌注。本研究旨在评估这些变量预测机械通气儿童急性肾损伤（AKI）的准确性。
连续纳入年龄<14 岁、接受有创机械通气 24 小时内接受肾脏多普勒超声检查的患儿。测量肾阻力指数（RRI）和肾搏动指数（RPI）。主要结局为第 3 天发生严重 AKI（KDIGO 分期 2 或 3）。
第 3 天，22 例患儿被分类为 AKI，其中 12 例为严重 AKI。RRI 能有效预测严重 AKI（ROC 曲线下面积[AUC]为 0.94）和 RPI（AUC 为 0.86）。RRI 的最佳截断值为 0.85（敏感性为 91.7%，特异性为 84.7%，PPV 为 50.0%，NPV 为 98.4%）。当评估第 5 天预测 AKI 的准确性时，也得到了类似的结果。RRI 与入组时（ρ=-0.495）和第 3 天（ρ=-0.467）的估算肾小球滤过率之间存在显著相关性。
肾脏多普勒超声可能是预测接受有创机械通气的危重病儿童 AKI 的一种很有前途的工具。
早期识别急性肾损伤（AKI）对于及时启动旨在恢复肾灌注的支持性治疗至关重要，这可能预防或减轻急性肾小管坏死。肾动脉多普勒参数是快速、无创和可重复的变量，可能对预测儿童 AKI 有前景。据我们所知，这是第一项评估基于肾多普勒的变量预测危重病儿童 AKI 的研究。本研究发现，基于多普勒的变量可以准确预测严重 AKI 的发生，并与尿量和利尿剂使用相关。
