Clinical phenotypes of acute kidney injury are associated with unique outcomes in critically ill septic children.
Clinical phenotypes of acute kidney injury are associated with unique outcomes in critically ill septic children.
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DOI：
10.1038/s41390-021-01363-3
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发表时间：
2021-11
影响因子：
3.6
通讯作者：
Goldstein SL
中科院分区：
文献类型：
--
作者：
Basu RK;Hackbarth R;Gillespie S;Akcan-Arikan A;Brophy P;Bagshaw S;Alobaidi R;Goldstein SL
脓毒症患者急性肾损伤（阿基）的评估仍然不准确。在成人中，根据临床阿基表型（严重程度和时间）对脓毒症患者进行分类，与广义阿基相比，显示出与患者结局的独特相关性。在一项多国前瞻性观察性研究中，根据持续时间（一过性vs.持续性）和严重程度（根据肌酐变化和尿量，轻度vs.重度）对重症脓毒症儿童的阿基诊断进行分层。关注的结局是28天时的死亡率和重症监护室资源复杂性。研究了757名败血症儿童（男性52.7%，年龄4.6岁（1.5-11.9））。死亡率（总体12.1%）在重度阿基和轻度阿基之间存在差异（18.3 vs. 4.4%，p < 0.001），重症监护室（ICU）复杂性也存在差异（总体34.5%，45 vs. 21.7%，p < 0.001）。与一过性阿基相比，持续性阿基患者的无ICU天数更少（17（7，21）vs. 24（17，26），p < 0.001），ICU复杂性更高（52.8 vs. 22.9%，p = 0.002），即使排除了早期死亡的患者。合并时间和严重程度数据的阿基表型与独特的生存率（范围4.4-21.6%）和无ICU天数（范围15-25天）相关。我们的研究结果强调了脓毒症和阿基预后富集对于试验设计和患者管理的重要性。虽然阿基通常发生在脓毒症（S-AKI）患者中，但S-AKI儿童的结局因阿基的严重程度和时间而异。现有的S-AKI儿科数据使用了广泛的单一肾损伤定义。提高阿基分类的精确度可以使人们对S-AKI与患者结局的关系有一个新的认识。S-AKI的精细分类确定了儿童的亚组，使S-AKI研究和管理的靶向和个性化医学方法成为可能。
Assessment of acute kidney injury (AKI) in septic patients remains imprecise. In adults, the classification of septic patients by clinical AKI phenotypes (severity and timing) demonstrates unique associations with patient outcome vs. broadly defined AKI. In a multinational prospective observational study, AKI diagnosis in critically ill septic children was stratified by duration (transient vs. persistent) and severity (mild vs. severe by creatinine change and urine output). The outcomes of interest were mortality and intensive care unit resource complexity at 28 days. Seven hundred and fifty-seven septic children were studied (male 52.7%, age 4.6 years (1.5–11.9)). Mortality (overall 12.1%) was different between severe AKI and mild AKI (18.3 vs. 4.4%, p < 0.001) as well as intensive care unit (ICU) complexity (overall 34.5%, 45 vs. 21.7%, p < 0.001). Patients with Persistent AKI had fewer ICU-free days (17 (7, 21) vs. 24 (17, 26), p < 0.001) and higher ICU complexity (52.8 vs. 22.9%, p = 0.002) than transient AKI, even after exclusion of patients with early mortality. AKI phenotypes incorporating temporal and severity data correlate with unique survival (range 4.4–21.6%) and ICU-free days (range of 15–25 days) The outcome of septic children with AKI changes by clinical phenotype. Our findings underscore the importance of prognostic enrichment in sepsis and AKI for the purpose of trial design and patient management. Although AKI occurs commonly in patients with sepsis (S-AKI), outcomes for children with S-AKI varies based on the severity and timing of the AKI. Existing S-AKI pediatric data utilize a broad singular definition of kidney injury. Increasing the precision of AKI classification results in a new understanding of how S-AKI associates with patient outcome. A refined classification of S-AKI identifies subgroups of children, making possible a targeted and a personalized medicine approach to S-AKI study and management.
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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：
4.2
作者：
McMahon, Blaithin A.;Galligan, Marie;Murray, Patrick T.
通讯作者：
Murray, Patrick T.
影响因子：
1.7
作者：
Hessey, Erin;Perreault, Sylvie;Zappitelli, Michael
通讯作者：
Zappitelli, Michael
影响因子：
4.3
作者：
Sarma, Aartik;Calfee, Carolyn S.;Ware, Lorraine B.
通讯作者：
Ware, Lorraine B.
DOI：
10.1159/000349964
发表时间：
2013-01-01
期刊：
ADQI CONSENSUS ON AKI BIOMARKERS AND CARDIORENAL SYNDROMES
影响因子：
--
作者：
Endre, Zoltan H.;Kellum, John A.;Murray, Patrick T.
通讯作者：
Murray, Patrick T.