Gist Katja M, Penk Jamie, Wald Eric L, Kitzmiller Laura, Webb Tennille N, Krallman Kelli, Brinton John, Soranno Danielle E, Goldstein Stuart L, Basu Rajit K
Department of Pediatrics, Division of Pediatric Cardiology, University of Colorado, Children's Hospital Colorado, Aurora, Colorado, United States.
Department of Pediatrics, Division of Pediatric Critical Care, Northwestern University, Ann and Robert H. Lurie Children's Hospital, Chicago, Illinois, United States.
J Pediatr Intensive Care. 2021 Jul 29;12(4):289-295. doi: 10.1055/s-0041-1732447. eCollection 2023 Dec.
A standardized, quantified assessment of furosemide responsiveness predicts acute kidney injury (AKI) in children after cardiac surgery and AKI progression in critically ill adults. The purpose of this study was to determine if response to furosemide is predictive of severe AKI in critically ill children outside of cardiac surgery. We performed a multicenter retrospective study of critically ill children. Quantification of furosemide response was based on urine flow rate (normalized for weight) measurement 0 to 6 hours after the dose. The primary outcome was presence of creatinine defined severe AKI (Kidney Disease Improving Global Outcomes stage 2 or greater) within 7 days of furosemide administration. Secondary outcomes included mortality, duration of mechanical ventilation and length of stay. A total of 110 patients were analyzed. Severe AKI occurred in 20% ( = 22). Both 2- and 6-hour urine flow rate were significantly lower in those with severe AKI compared with no AKI ( = 0.002 and < 0.001). Cutoffs for 2- and 6-hour urine flow rate for prediction of severe AKI were <4 and <3 mL/kg/hour, respectively. The adjusted odds of developing severe AKI for 2-hour urine flow rate of <4 mL/kg/hour was 4.3 (95% confidence interval [CI]: 1.33-14.15; = 0.02). The adjusted odds of developing severe AKI for 6-hour urine flow rate of <3 mL/kg/hour was 6.19 (95% CI: 1.85-20.70; = 0.003). Urine flow rate in response to furosemide is predictive of severe AKI in critically ill children. A prospective assessment of urine flow rate in response to furosemide for predicting subsequent severe AKI is warranted.
对速尿反应性进行标准化、量化评估可预测心脏手术后儿童的急性肾损伤（AKI）以及危重症成人的AKI进展。本研究的目的是确定速尿反应是否可预测非心脏手术的危重症儿童发生严重AKI。我们对危重症儿童进行了一项多中心回顾性研究。速尿反应的量化基于给药后0至6小时的尿流率（按体重标准化）测量。主要结局是在速尿给药后7天内出现肌酐定义的严重AKI（改善全球肾脏病预后组织2期或更高分期）。次要结局包括死亡率、机械通气时间和住院时间。共分析了110例患者。20%（n = 22）发生了严重AKI。与未发生AKI者相比，严重AKI患者的2小时和6小时尿流率均显著降低（P = 0.002和P < 0.001）。预测严重AKI的2小时和6小时尿流率临界值分别为<4和<3 mL/kg/小时。2小时尿流率<4 mL/kg/小时发生严重AKI的校正比值比为4.3（95%置信区间[CI]：1.33 - 14.15；P = 0.02）。6小时尿流率<3 mL/kg/小时发生严重AKI的校正比值比为6.19（95%CI：1.85 - 20.70；P = 0.003）。速尿反应的尿流率可预测危重症儿童发生严重AKI。有必要对速尿反应的尿流率进行前瞻性评估以预测随后的严重AKI。
