The outcome of acute kidney injury substages based on urinary cystatin C in critically ill children.
The outcome of acute kidney injury substages based on urinary cystatin C in critically ill children.
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DOI：
10.1186/s13613-023-01119-8
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发表时间：
2023-03-28
影响因子：
8.1
通讯作者：
中科院分区：
文献类型：
--
作者：
急性肾损伤（阿基）亚期的概念已被推荐用于更好地表型阿基和识别高风险患者群体，从而提高阿基的诊断准确性。然而，建议与临床应用之间仍存在差距。该研究旨在探索基于尿胱抑素C（uCysC）的敏感阿基生物标志物的阿基亚阶段的发生率，并确定阿基亚阶段是否与危重儿童的结局相关。该多中心队列研究纳入了中国四家三级医院儿科重症监护室（PICU）的793名儿童。根据PICU入院时uCysC水平将患儿分为非AKI、亚AKI和阿基亚期A和B。亚AKI定义为不符合KDIGO阿基标准的儿童入院时uCysC水平≥ 1.26 mg/g uCr。在符合KDIGO标准的儿童中，uCysC < 1.26定义为阿基亚期A，≥ 1.26定义为阿基亚期B。评估阿基亚型与30天PICU死亡率的相关性。15.6%（124/793）的患者符合亚AKI的定义。在180例（22.7%）阿基患者中，90例（50%）为uCysC阳性阿基B亚期，与A亚期相比，更可能为经典阿基3期。与非AKI相比，亚AKI和阿基亚期A和B是与死亡率显著相关的风险因素，调整混杂因素后，亚AKI（调整后风险比HR = 2.42）和阿基亚期B（调整后HR = 2.83）与死亡率的相关性仍然显著。此外，与亚AKI（HR = 3.10）和阿基亚A（HR = 3.19）相比，阿基亚期B的死亡风险增加。20.2%的无阿基患者发生了根据uCysC定义/基于uCysC的亚AKI，与阿基亚期A患者的死亡风险接近。尿CysC阳性阿基B亚期发生在50%的阿基患者中，更有可能发生经典的阿基3期，并与最高的死亡风险相关。在线版本包含补充材料，可通过10.1186/s13613-023-01119-8获得。
The concept of acute kidney injury (AKI) substages has been recommended to better phenotype AKI and identify high-risk patient groups and therefore improve the diagnostic accuracy of AKI. However, there remains a gap between the recommendation and the clinical application. The study aimed to explore the incidence of AKI substages based on a sensitive AKI biomarker of urinary cystatin C (uCysC), and to determine whether AKI substages were relevant with respect to outcome in critically ill children. The multicenter cohort study enrolled 793 children in pediatric intensive care unit (PICU) of four tertiary hospitals in China. Children were classified as non-AKI, sub-AKI and AKI substages A and B according to uCysC level at PICU admission. Sub-AKI was defined by admission uCysC level ≥ 1.26 mg/g uCr in children not meeting the KDIGO criteria of AKI. In children who fulfilled KDIGO criteria, those with uCysC < 1.26 was defined as AKI substage A, and with ≥ 1.26 defined as AKI substage B. The associations of AKI substages with 30-day PICU mortality were assessed. 15.6% (124/793) of patients met the definition of sub-AKI. Of 180 (22.7%) patients with AKI, 90 (50%) had uCysC-positive AKI substage B and were more likely to have classical AKI stage 3, compared to substage A. Compared to non-AKI, sub-AKI and AKI substages A and B were risk factors significantly associated with mortality, and the association of sub-AKI (adjusted hazard ratio HR = 2.42) and AKI substage B (adjusted HR = 2.83) with mortality remained significant after adjustment for confounders. Moreover, AKI substage B had increased risks of death as compared with sub-AKI (HR = 3.10) and AKI substage A (HR = 3.19). Sub-AKI defined/based on uCysC occurred in 20.2% of patients without AKI and was associated with a risk of death close to patients with AKI substage A. Urinary CysC-positive AKI substage B occurred in 50% of AKI patients and was more likely to have classical AKI stage 3 and was associated with the highest risk of mortality. The online version contains supplementary material available at 10.1186/s13613-023-01119-8.
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DOI：
10.1056/nejmoa1611391
发表时间：
2017-01-05
期刊：
The New England journal of medicine
影响因子：
--
作者：
Kaddourah A;Basu RK;Bagshaw SM;Goldstein SL;AWARE Investigators
通讯作者：
AWARE Investigators
影响因子：
3.4
作者：
Elitok S;Devarajan P;Bellomo R;Isermann B;Haase M;Haase-Fielitz A
通讯作者：
Haase-Fielitz A
影响因子：
3.3
作者：
Moledina DG;Parikh CR
通讯作者：
Parikh CR
影响因子：
81.5
作者：
Kellum, John A.;Romagnani, Paola;Anders, Hans-Joachim
通讯作者：
Anders, Hans-Joachim
DOI：
10.1016/j.jtcvs.2017.12.056
发表时间：
2018-06-01
影响因子：
6
作者：
Albert, Christian;Albert, Annemarie;Haase-Fielitz, Anja
通讯作者：
Haase-Fielitz, Anja