Epidemiology of Acute Kidney Injury in Critically Ill Children and Young Adults.
Epidemiology of Acute Kidney Injury in Critically Ill Children and Young Adults.
复制标题
DOI：
10.1056/nejmoa1611391
复制
发表时间：
2017-01-05
期刊：
影响因子：
--
通讯作者：
AWARE Investigators
中科院分区：
文献类型：
--
作者：
Kaddourah A;Basu RK;Bagshaw SM;Goldstein SL;AWARE Investigators
儿童和青年急性肾损伤的流行病学特征已在单中心和回顾性研究中描述。我们进行了一项涉及儿科重症监护病房的患者的多国前瞻性研究，以确定与严重急性肾损伤相关的死亡和并发症的增量风险。我们使用肾脏疾病：改善全球结局标准来定义急性肾损伤。重度急性肾损伤定义为2期或3期急性肾损伤（血浆肌酐水平≥基线水平的2倍或尿量<0.5 ml / kg体重/小时≥12小时），并在重症监护的前7天进行评估。所有在32个参与单位中的1个单位住院的3个月至25岁的患者连续3个月进行筛查。主要终点为28天死亡率。共评估4683例患者；1261例患者发生急性肾损伤（26.9%，95%可信区间[CI]， 25.6 ~ 28.2）， 543例患者发生重度急性肾损伤（11.6%,95% CI, 10.7 ~ 12.5）。16个协变量校正后，严重急性肾损伤在第28天死亡风险增加（校正优势比1.77;95% CI， 1.17至2.68）；543例严重急性肾损伤患者中有60例（11.0%）死亡，而4140例非严重急性肾损伤患者中有105例（2.5%）死亡（P<0.001）。严重急性肾损伤与机械通气和肾脏替代治疗的使用增加有关。28天死亡率的逐步增加与急性肾损伤严重程度的恶化相关（log-rank检验P<0.001）。仅根据血浆肌酐水平评估急性肾损伤不能识别67.2%的低尿量患者的急性肾损伤。急性肾损伤在危重儿童和年轻人中很常见，并与不良预后相关，包括死亡率增加。（由辛辛那提儿童医院医学中心儿科肾病卓越中心和其他机构资助；AWARE ClinicalTrials.gov号码，NCT01987921。）
The epidemiologic characteristics of children and young adults with acute kidney injury have been described in single-center and retrospective studies. We conducted a multinational, prospective study involving patients admitted to pediatric intensive care units to define the incremental risk of death and complications associated with severe acute kidney injury. We used the Kidney Disease: Improving Global Outcomes criteria to define acute kidney injury. Severe acute kidney injury was defined as stage 2 or 3 acute kidney injury (plasma creatinine level ≥2 times the baseline level or urine output <0.5 ml per kilogram of body weight per hour for ≥12 hours) and was assessed for the first 7 days of intensive care. All patients 3 months to 25 years of age who were admitted to 1 of 32 participating units were screened during 3 consecutive months. The primary outcome was 28-day mortality. A total of 4683 patients were evaluated; acute kidney injury developed in 1261 patients (26.9%; 95% confidence interval [CI], 25.6 to 28.2), and severe acute kidney injury developed in 543 patients (11.6%; 95% CI, 10.7 to 12.5). Severe acute kidney injury conferred an increased risk of death by day 28 after adjustment for 16 covariates (adjusted odds ratio, 1.77; 95% CI, 1.17 to 2.68); death occurred in 60 of the 543 patients (11.0%) with severe acute kidney injury versus 105 of the 4140 patients (2.5%) without severe acute kidney injury (P<0.001). Severe acute kidney injury was associated with increased use of mechanical ventilation and renal-replacement therapy. A stepwise increase in 28-day mortality was associated with worsening severity of acute kidney injury (P<0.001 by log-rank test). Assessment of acute kidney injury according to the plasma creatinine level alone failed to identify acute kidney injury in 67.2% of the patients with low urine output. Acute kidney injury is common and is associated with poor outcomes, including increased mortality, among critically ill children and young adults. (Funded by the Pe-diatric Nephrology Center of Excellence at Cincinnati Children’s Hospital Medical Center and others; AWARE ClinicalTrials.gov number, NCT01987921.)