Acute Kidney Injury in Children Hospitalized With Diarrheal Illness in the United States.
Acute Kidney Injury in Children Hospitalized With Diarrheal Illness in the United States.
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DOI：
10.1542/hpeds.2019-0220
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发表时间：
2019-12-01
影响因子：
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通讯作者：
Anand, Shuchi
中科院分区：
文献类型：
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作者：
Bradshaw, Christina;Han, Jialin;Anand, Shuchi
目的：确定美国腹泻住院儿童急性肾损伤（AKI）的发生率、相关性和后果。方法：利用2009年和2012年儿童住院患者数据库的数据，研究初步诊断为腹泻病的住院儿童（加权N = 113195）。我们使用国际疾病分类，第九版，临床修改，诊断代码584.5至584.9来捕获AKI。我们使用逐步logistic回归和广义线性模型计算AKI与住院腹泻疾病相关的发病率、相关性和后果（死亡率、住院时间[LOS]和费用）。结果：腹泻住院患儿AKI的平均发生率为0.8%。医院位置和教学状况与AKI发生率相关，年龄、实体器官移植、高血压、慢性肾脏疾病、风湿病和血液病也与AKI发生率相关。住院腹泻患者发生AKI与住院死亡率增加8倍相关（优势比8.0；95%可信区间[CI] 4.2-15.4）。AKI与LOS延长（平均增加3.0天；95% CI 2.3-3.8）和更高的住院费用（平均增加9241美元；95% CI 4661- 13820美元）相关。结论：一些人口统计学因素和合并症与腹泻住院儿童AKI的风险相关。虽然罕见，但AKI在这一常见儿科疾病中的发展与死亡率、LOS和住院费用的增加有关。
OBJECTIVES: To determine the incidence, correlates, and consequences of acute kidney injury (AKI) among children hospitalized with diarrheal illness in the United States.METHODS: Using data from Kids' Inpatient Database in 2009 and 2012, we studied children hospitalized with a primary diagnosis of diarrheal illness (weighted N = 113195). We used the International Classification of Diseases, Ninth Revision, Clinical Modification, diagnosis codes 584.5 to 584.9 to capture AKI. We calculated the incidence, correlates, and consequences (mortality, length of stay [LOS], and costs) of AKI associated with hospitalized diarrheal illness using stepwise logistic regression and generalized linear models.RESULTS: The average incidence of AKI in children hospitalized with diarrheal illness was 0.8%. Hospital location and teaching status were associated with the odds of AKI, as were older age, solid organ transplant, hypertension, chronic kidney disease, and rheumatologic and hematologic conditions. The development of AKI in hospitalized diarrheal illness was associated with an eightfold increase in the odds of in-hospital mortality (odds ratio 8.0; 95% confidence interval [CI] 4.2-15.4). AKI was associated with prolonged LOS (mean increase 3.0 days; 95% CI 2.3-3.8) and higher hospital cost (mean increase $9241; 95% CI $4661-$13820).CONCLUSIONS: Several demographic factors and comorbid conditions are associated with the risk of AKI in children hospitalized with diarrheal illness. Although rare, development of AKI in this common pediatric condition is associated with increased mortality, LOS, and hospital cost.