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.
Department of Pediatrics, AORN Sant'Anna e San Sebastiano, via Ferdinando Palasciano, 81100, Caserta, Italy.
Eur J Pediatr. 2023 Aug;182(8):3569-3576. doi: 10.1007/s00431-023-05029-6. Epub 2023 May 24.
We investigated prevalence of and factors associated with acute kidney injury (AKI) in a group of patients hospitalized with viral bronchiolitis. We retrospectively enrolled 139 children (mean age = 3.2 ± 2.1 months; males = 58.9%) hospitalized for viral bronchiolitis in a non-pediatric intensive care unit (PICU) setting. The Kidney Disease/Improving Global Outcomes creatinine criterion was used to diagnose AKI. We estimated basal serum creatinine by back-calculating it by Hoste (age) equation assuming that basal eGFR were the median age-based eGFR normative values. Univariate and multivariate logistic regression models were used to explore associations with AKI. Out of 139 patients, AKI was found in 15 (10.8%). AKI was found in 13 out of 74 (17.6%) patients with and in 2 out of 65 (3.1%) without respiratory syncytial virus (RSV) infection (p = 0.006). No patient required renal replacement therapies, while 1 out of 15 (6.7%) developed AKI stage 3, 1 (6.7%) developed AKI stage 2, and 13 (86.6%) developed AKI stage 1. Among the 15 patients with AKI, 13 (86.6%) reached the maximum AKI stage at admission, 1 (6.7%) at 48 h, and 1 (6.7%) at 96 h. At multivariate analysis, birth weight < 10th percentile (odds ratio, OR = 34.1; 95% confidence interval, CI = 3.6-329.4; p = 0.002), preterm birth (OR = 20.3; 95% CI = 3.1-129.5; p = 0.002), RSV infection (OR = 27.0; 95% CI = 2.6-279.9; p = 0.006), and hematocrit levels > 2 standard deviation score (SDS) (OR = 22.4; 95% CI = 2.8-183.6; p = 0.001) were significantly associated with AKI.
About 11% of patients hospitalized with viral bronchiolitis in a non-PICU setting develop an AKI (frequently mild in degree). Preterm birth, birth weight < 10th percentile, hematocrit levels > 2SDS, and RSV infection are significantly associated with AKI in the setting of viral bronchiolitis.
• Viral bronchiolitis affects children in the first months of life and in 7.5% of cases it can be complicated by acute kidney injury (AKI). • No studies investigated associations with AKI in infants hospitalized for viral bronchiolitis.
• About 11% of patients hospitalized with viral bronchiolitis can develop an AKI (frequently mild in degree). • Preterm birth, birth weight <10th percentile, hematocrit levels > 2 standard deviation score, and respiratory syncytial virus infection are associated with AKI development in infants with viral bronchiolitis.
我们调查了一组因病毒性毛细支气管炎住院的患者中急性肾损伤（AKI）的患病率及其相关因素。
我们回顾性纳入了 139 名在非儿科重症监护病房（PICU）因病毒性毛细支气管炎住院的儿童（平均年龄 3.2±2.1 个月；男性占 58.9%）。使用肾脏病/改善全球预后（KDIGO）肌酐标准诊断 AKI。我们通过回推 Hos-te（年龄）方程估算基础血清肌酐，假设基础 eGFR 为基于年龄的 eGFR 中值正常值。使用单变量和多变量逻辑回归模型来探讨与 AKI 的关联。
在 139 例患者中，15 例（10.8%）发生 AKI。74 例有呼吸道合胞病毒（RSV）感染的患者中 13 例（17.6%）和 65 例无 RSV 感染的患者中 2 例（3.1%）发生 AKI（p=0.006）。无患者需要肾脏替代治疗，15 例 AKI 患者中 1 例（6.7%）发展为 AKI 3 期，1 例（6.7%）发展为 AKI 2 期，13 例（86.6%）发展为 AKI 1 期。在 15 例 AKI 患者中，13 例（86.6%）在入院时达到 AKI 的最大分期，1 例（6.7%）在 48 小时时，1 例（6.7%）在 96 小时时。多变量分析显示，出生体重<第 10 百分位数（比值比，OR=34.1；95%置信区间，CI=3.6-329.4；p=0.002）、早产（OR=20.3；95%CI=3.1-129.5；p=0.002）、RSV 感染（OR=27.0；95%CI=2.6-279.9；p=0.006）和红细胞压积水平>2 个标准差得分（OR=22.4；95%CI=2.8-183.6；p=0.001）与 AKI 显著相关。
约 11%因病毒性毛细支气管炎在非 PICU 住院的患者发生 AKI（通常为轻度）。早产、出生体重<第 10 百分位数、红细胞压积水平>2 个标准差得分和 RSV 感染与病毒性毛细支气管炎患者 AKI 的发生显著相关。
