Serum creatinine as stratified in the RIFLE score for acute kidney injury is associated with mortality and length of stay for children in the pediatric intensive care unit
Serum creatinine as stratified in the RIFLE score for acute kidney injury is associated with mortality and length of stay for children in the pediatric intensive care unit
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DOI：
10.1097/ccm.0b013e3181cd12e1
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发表时间：
2010-03-01
影响因子：
8.8
通讯作者：
Bart, Robert
中科院分区：
文献类型：
--
作者：
Schneider, James;Khemani, Robinder;Bart, Robert
目的：评价RIFE标准对危重儿童急性肾损伤的诊断能力。设计：对前瞻性收集的临床数据进行回顾性分析。地点：多学科、三级护理、20个床位的儿科重症监护室。患者：2003年7月至2007年3月期间的3396例住院患者。干预：非。测量和主要结果：每个患者的RIFE评分是基于血清肌酐较基线的百分比变化计算的(风险=血肌酐x 1.5；损伤=血清肌酐x 2；失败=血清肌酐x 3)。主要结果衡量指标为死亡率和重症监护病房住院时间。分别用Logistic回归和线性回归控制潜在的混杂因素，并确定步枪得分与死亡率和住院时间之间的关联。194例(5.7%)患者在入院时有不同程度的急性肾损伤，339例(10%)患者在儿科重症监护病房期间发生了急性肾损伤。几乎一半的急性肾损伤患者在重症监护病房入院后24小时内步枪得分最高，约75%的患者在重症监护病房第七天达到最大步枪得分。经过回归分析，入院时的任何急性肾损伤以及在儿科重症监护病房期间任何急性肾损伤的发展或恶化都与死亡率的增加独立相关，死亡率的几率随着步枪得分的每一级的增加而增加(P<；.01)。入院时患有急性肾损伤的患者的住院时间是肾功能正常患者的两倍，而在儿科重症监护病房期间发生任何急性肾脏损伤的患者的住院时间是儿科重症监护病房患者的四倍。此外，在控制了相同的高危协变量后，除了与步枪风险评分一起入院外，儿科重症监护病房入院时的任何急性肾损伤、儿科重症监护病房病程中出现的任何急性肾损伤、儿科重症监护病房病程中任何恶化的步枪评分以及儿科重症监护病房住院时间的增加都是独立的关系(p<；.01)。结论：步枪标准可以很好地描述危重儿童患者的急性肾损伤。(Crit Care Med 2010；38：933-939)
Objective: To evaluate the ability of the RIFLE criteria to characterize acute kidney injury in critically ill children.Design: Retrospective analysis of prospectively collected clinical data.Setting: Multidisciplinary, tertiary care, 20-bed pediatric intensive care unit.Patients: All 3396 admissions between July 2003 and March 2007.Interventions: None.Measurements and Main Results: A RIFLE score was calculated for each patient based on percent change of serum creatinine from baseline (risk = serum creatinine x 1.5; injury = serum creatinine x 2; failure = serum creatinine x 3). Primary outcome measures were mortality and intensive care unit length of stay. Logistic and linear regressions were performed to control for potential confounders and determine the association between RIFLE score and mortality and length of stay, respectively. One hundred ninety-four (5.7%) patients had some degree of acute kidney injury at the time of admission, and 339 (10%) patients had acute kidney injury develop during the pediatric intensive care unit course. Almost half of all patients with acute kidney injury had their maximum RIFLE score within 24 hrs of intensive care unit admission, and approximately 75% achieved their maximum RIFLE score by the seventh intensive care unit day. After regression analysis, any acute kidney injury on admission and any development of or worsening of acute kidney injury during the pediatric intensive care unit stay were independently associated with increased mortality, with the odds of mortality increasing with each grade increase in RIFLE score (p < .01). Patients with acute kidney injury at the time of admission had a length of stay twice that of those with normal renal function, and those who had any acute kidney injury develop during the pediatric intensive care unit course had a four-fold increase in pediatric intensive care unit length of stay. Also, other than being admitted with RIFLE risk score, an independent relationship between any acute kidney injury at the time of pediatric intensive care unit admission, any acute kidney injury present during the pediatric intensive care unit course, or any worsening RIFLE scores during the pediatric intensive care unit course and increased pediatric intensive care unit length of stay were identified after controlling for the same high-risk covariates (p < .01).Conclusions: RIFLE criteria serves well to describe acute kidney injury in critically ill pediatric patients. (Crit Care Med 2010; 38: 933-939)