Almuqamam Mohamed, Novi Brian, Rossini Connie J, Mammen Ajit, DeSanti Ryan L
Department of Pediatrics, Drexel University College of Medicine, St. Christopher's Hospital for Children, Philadelphia, PA, USA.
Department of Surgery, Drexel University College of Medicine, St. Christopher's Hospital for Children, Philadelphia, PA, USA.
Childs Nerv Syst. 2023 May;39(5):1267-1275. doi: 10.1007/s00381-022-05810-2. Epub 2023 Jan 3.
Acute kidney injury (AKI) is an established complication of adult traumatic brain injury (TBI) and known risk factor for mortality. Evidence demonstrates an association between hyperchloremia and AKI in critically ill adults but studies in children are scarce. Given frequent use of hypertonic saline in the management of pediatric TBI, we believe the incidence of hyperchloremia will be high and hypothesize that it will be associated with development of AKI.
Single-center retrospective cohort study was completed at an urban, level 1 pediatric trauma center. Children > 40 weeks corrected gestational age and < 21 years of age with moderate or severe TBI (presenting GCS < 13) admitted between January 2016 and December 2021 were included. Primary study outcome was presence of AKI (defined by pediatric Kidney Disease: Improving Global Outcomes criteria) within 7 days of hospitalization and compared between patients with and without hyperchloremia (serum chloride ≥ 110 mEq/L).
Fifty-two children were included. Mean age was 5.75 (S.D. 5.4) years; 60% were male (31/52); and mean presenting GCS was 6 (S.D. 2.9). Thirty-seven patients (71%) developed hyperchloremia with a mean peak chloride of 125 (S.D. 12.0) mEq/L and mean difference between peak and presenting chloride of 16 (S.D. 12.7) mEq/L. Twenty-three patients (44%) developed AKI; of those with hyperchloremia, 62% (23/37) developed AKI, while among those without hyperchloremia, 0% (0/15) developed AKI (difference 62%, 95% CI 42-82%, p < 0.001). Attributable risk of hyperchloremia leading to AKI was 62.2 (95% CI 46.5-77.8, p = 0.0015).
Hyperchloremia is common in the management of pediatric TBI and is associated with development of AKI. Risk appears to be associated with both the height of serum chloride and duration of hyperchloremia.
急性肾损伤（AKI）是成人创伤性脑损伤（TBI）的一种既定并发症，也是已知的死亡风险因素。有证据表明，在危重症成人中，高氯血症与AKI之间存在关联，但儿童相关研究较少。鉴于高渗盐水在小儿TBI治疗中经常使用，我们认为高氯血症的发生率会很高，并假设它与AKI的发生有关。
在一家城市一级儿科创伤中心完成了单中心回顾性队列研究。纳入2016年1月至2021年12月期间收治的校正胎龄>40周且年龄<21岁、患有中度或重度TBI（入院时格拉斯哥昏迷评分[GCS]<13）的儿童。主要研究结局是住院7天内是否发生AKI（根据儿童肾脏病改善全球预后标准定义），并在有和无高氯血症（血清氯≥110 mEq/L）的患者之间进行比较。
共纳入52名儿童。平均年龄为5.75（标准差5.4）岁；60%为男性（31/52）；入院时平均GCS为6（标准差2.9）。37例患者（71%）发生高氯血症，平均最高氯值为125（标准差12.0）mEq/L，最高氯值与入院时氯值的平均差值为16（标准差12.7）mEq/L。23例患者（44%）发生AKI；在发生高氯血症的患者中，62%（23/37）发生AKI，而在未发生高氯血症的患者中，0%（0/15）发生AKI（差异62%，95%可信区间42%-82%，p<0.001）。高氯血症导致AKI的归因风险为62.2（95%可信区间46.5-77.8，p=0.0015）。
高氯血症在小儿TBI治疗中很常见，且与AKI的发生有关。风险似乎与血清氯水平及高氯血症持续时间均有关。
