Incidence and outcomes of neonatal acute kidney injury (AWAKEN): a multicentre, multinational, observational cohort study.
Incidence and outcomes of neonatal acute kidney injury (AWAKEN): a multicentre, multinational, observational cohort study.
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DOI：
10.1016/s2352-4642(17)30069-x
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发表时间：
2017-11
期刊：
影响因子：
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通讯作者：
Neonatal Kidney Collaborative (NKC)
中科院分区：
文献类型：
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作者：
Jetton JG;Boohaker LJ;Sethi SK;Wazir S;Rohatgi S;Soranno DE;Chishti AS;Woroniecki R;Mammen C;Swanson JR;Sridhar S;Wong CS;Kupferman JC;Griffin RL;Askenazi DJ;Neonatal Kidney Collaborative (NKC)
单中心研究表明，新生儿急性肾损伤（AKI）与不良预后相关。然而，由于这些研究的样本量较小，有关AKI、死亡率和住院时间之间关系的推断是有限的。为了确定新生儿AKI是否与死亡率增加和住院时间延长独立相关，我们分析了全球新生儿急性肾脏流行病学评估（AWAKEN）数据库。对2014年1月1日至3月31日期间来自四个国家（澳大利亚、加拿大、印度、美国）的24个新生儿重症监护病房的所有新生儿进行筛查。在筛选的4273名新生儿中，2022名（47.3%）符合研究标准。排除标准包括：没有静脉输液≥48小时，入院≥14天，先天性心脏病需要手术修复<7天，致命的染色体异常，48小时内死亡，无法确定AKI状态或严重的先天性肾脏异常。AKI是使用标准化定义来定义的。血清肌酐升高≥0.3 mg/dL （26.5 mcmol/L）或较先前最低值升高≥50%，和/或产后2至7天尿量<1 mL/kg/h。AKI的发生率为605/2022（29.9%）。不同胎龄组的发生率不同（即≥22至<29周= 47.9%，≥29至<36周= 18.3%，≥36周= 36.7%）。即使在调整了多个潜在的混杂因素后，患有AKI的婴儿的死亡率也高于没有AKI的婴儿[59/605 (9.7%)vs. 20/1417 (1.4%)；p < 0.001;调整后OR= 4.6 (95% CI= 2.5 - 8.3)；p=< 0.0001]，住院时间更长[调整参数估计为8.8天（95% CI= 6.1 - 11.5）；p < 0·0001)。新生儿AKI是死亡率和住院时间延长的一个常见和独立的危险因素。这些数据表明，新生儿可能受到AKI的影响，其方式与儿科和成人患者相似。美国国立卫生研究院，伯明翰阿拉巴马大学，辛辛那提儿童医院，新墨西哥大学。
Single-center studies suggest that neonatal acute kidney injury (AKI) is associated with poor outcomes. However, inferences regarding the association between AKI, mortality, and hospital length of stay are limited due to the small sample size of those studies. In order to determine whether neonatal AKI is independently associated with increased mortality and longer hospital stay, we analyzed the Assessment of Worldwide Acute Kidney Epidemiology in Neonates (AWAKEN) database. All neonates admitted to 24 participating neonatal intensive care units from four countries (Australia, Canada, India, United States) between January 1 and March 31, 2014, were screened. Of 4273 neonates screened, 2022 (47·3%) met study criteria. Exclusion criteria included: no intravenous fluids ≥48 hours, admission ≥14 days of life, congenital heart disease requiring surgical repair at <7 days of life, lethal chromosomal anomaly, death within 48 hours, inability to determine AKI status or severe congenital kidney abnormalities. AKI was defined using a standardized definition —i.e., serum creatinine rise of ≥0.3 mg/dL (26.5 mcmol/L) or ≥50% from previous lowest value, and/or if urine output was <1 mL/kg/h on postnatal days 2 to 7. Incidence of AKI was 605/2022 (29·9%). Rates varied by gestational age groups (i.e., ≥22 to <29 weeks =47·9%; ≥29 to <36 weeks =18·3%; and ≥36 weeks =36·7%). Even after adjusting for multiple potential confounding factors, infants with AKI had higher mortality compared to those without AKI [(59/605 (9·7%) vs. 20/1417 (1·4%); p< 0.001; adjusted OR=4·6 (95% CI=2·5–8·3); p=<0·0001], and longer hospital stay [adjusted parameter estimate 8·8 days (95% CI=6·1–11·5); p<0·0001]. Neonatal AKI is a common and independent risk factor for mortality and longer hospital stay. These data suggest that neonates may be impacted by AKI in a manner similar to pediatric and adult patients. US National Institutes of Health, University of Alabama at Birmingham, Cincinnati Children’s, University of New Mexico.