Pennsylvania State University College of Medicine, Hershey, Pennsylvania, United States of America.
Pediatric Critical Care Medicine, Department of Pediatrics, Penn State Hershey Children's Hospital, Hershey, Pennsylvania, United States of America.
PLoS One. 2024 Mar 21;19(3):e0298463. doi: 10.1371/journal.pone.0298463. eCollection 2024.
Acute kidney injury (AKI) is a common complication in hospitalized pediatric patients. Previous studies focused on adults found that proteinuria detected during an admission urinalysis is fit to serve as an indicator for AKI and associated clinical outcomes. The objective of this study is to evaluate if proteinuria on the first day of hospital services in hospitalized children is associated with AKI, need for renal replacement therapy, shock and/or antibiotic use, critical care services, and all-cause mortality at 30 days, hypothesizing that it is associated with these outcomes.
This is a retrospective cohort study using TriNetX electronic health record data of patients 2 to 18 years of age who underwent urinalysis laboratory testing on hospital admission, had three subsequent days of hospital or critical care services billing codes and creatinine laboratory values, and no pre-existing renal-related complex chronic condition. This study evaluated for the frequency, odds, and severity of AKI as defined by Kidney Disease: Improving Global Outcomes modified criteria and assessed for associated clinical outcomes.
This study included 971 pediatric subjects [435 (44.7%) with proteinuria]. Proteinuria on the first day of hospital services was associated with an increased odds for higher severity AKI on any day of hospitalization (odds ratio [OR] 2.41, CI 1.8-3.23, p<0.001), need for renal replacement therapy (OR 4.58, CI 1.69-12.4, p = 0.001), shock and/or antibiotic use (OR 1.34, CI 1.03-1.75, p = 0.033), and all-cause mortality at 30 days post-admission (OR 10.0, CI 1.25-80.5, p = 0.013).
Children with proteinuria on the first day of hospital care services may have an increased odds of higher severity AKI, need for renal replacement therapy, shock and/or antibiotic use, and all-cause mortality at 30 days post-admission, with no significant association found for critical care services, mechanical intubation, or inotrope or vasopressor use.
急性肾损伤（AKI）是住院儿科患者的常见并发症。既往研究主要针对成年人，发现住院期间尿液分析中出现的蛋白尿适合作为 AKI 及相关临床结局的指标。本研究旨在评估住院儿童在入院第 1 天的蛋白尿是否与 AKI、肾脏替代治疗的需求、休克和/或抗生素使用、重症监护服务以及 30 天全因死亡率相关，假设其与这些结局相关。
这是一项使用 TriNetX 电子病历数据的回顾性队列研究，纳入年龄在 2 至 18 岁之间、在入院时进行尿液分析实验室检查、随后 3 天有住院或重症监护服务计费代码和肌酐实验室值、且无预先存在的与肾脏相关的复杂慢性疾病的患者。本研究评估了根据改善全球肾脏病预后组织（KDIGO）改良标准定义的 AKI 的频率、比值比（OR）和严重程度，并评估了相关临床结局。
本研究纳入了 971 例儿科患者[435 例（44.7%）有蛋白尿]。入院第 1 天的蛋白尿与住院期间任何一天更高严重程度 AKI 的发生几率增加相关（OR 2.41，95%CI 1.8-3.23，p<0.001），需要肾脏替代治疗（OR 4.58，95%CI 1.69-12.4，p=0.001）、休克和/或抗生素使用（OR 1.34，95%CI 1.03-1.75，p=0.033），以及入院后 30 天的全因死亡率（OR 10.0，95%CI 1.25-80.5，p=0.013）。
入院第 1 天有蛋白尿的儿童发生更严重 AKI、需要肾脏替代治疗、休克和/或抗生素使用以及入院后 30 天全因死亡率的几率增加，但与重症监护服务、机械通气、或正性肌力药或血管加压药使用无显著相关性。
