Acute kidney injury is an independent risk factor for pediatric intensive care unit mortality, longer length of stay and prolonged mechanical ventilation in critically ill children: a two-center retrospective cohort study.
Acute kidney injury is an independent risk factor for pediatric intensive care unit mortality, longer length of stay and prolonged mechanical ventilation in critically ill children: a two-center retrospective cohort study.
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DOI：
10.1186/cc10269
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发表时间：
2011-06-10
期刊：
影响因子：
--
通讯作者：
Zappitelli M
中科院分区：
文献类型：
--
作者：
Alkandari O;Eddington KA;Hyder A;Gauvin F;Ducruet T;Gottesman R;Phan V;Zappitelli M
在成人中，血清肌酐（SCr）小幅（< 50%）升高可预测死亡率。目前尚不清楚不同的基线血清肌酐（bSCr）估计方法是否会影响急性肾损伤（阿基）-结局相关性的结果。我们描述了儿科阿基的特征，评估了bSCr估计方法对AKI结局相关性的影响，并评估了SCr小幅增加预测阿基发展的作用。我们对在加拿大魁北克省蒙特利尔的两个儿科重症监护室（PICU）住院至少一晚的儿童（不包括术后心脏或肾移植患者）进行了一项回顾性队列数据库研究。阿基的定义基于急性肾损伤网络分期系统，不包括48小时内SCr升高的要求，根据我们的数据集无法进行评估。我们用两种方法估算bSCr：（1）入院前3个月的最低SCr水平或基于年龄和性别的平均标准（标准方法）或（2）使用所有患者的平均标准。结果是PICU死亡率和住院时间以及所需的机械通气。我们使用多元逻辑回归分析来评估阿基危险因素以及阿基与死亡率之间的关联。我们使用多元线性回归分析来评估阿基对其他结局的影响。我们计算了早期SCr增加（< 50%）的诊断特征，以预测阿基的发展。在2，106例入院患者（平均年龄± SD = 5.0 ± 5.5岁; 47%为女性）中，377例患者（17.9%）在PICU入院期间发生阿基（使用标准bSCr方法）。较高的儿科死亡风险评分、需要机械通气、记录感染和进行bSCr测量是阿基发展的独立预测因素。阿基与死亡率增加相关（使用标准bSCr方法，校正比值比（OR）= 3.7，95%置信区间（95% CI）= 2.1至6.4;使用所有患者的标准bSCr值，OR = 4.5，95% CI = 2.6至7.9）。阿基与PICU停留时间延长和需要机械通气独立相关。在未发生阿基的儿童中，初始SCr百分比增加可预测阿基的发生（曲线下面积= 0.67，95% CI = 0.60 - 0.74）。无论使用何种bSCr，阿基均与危重儿童的死亡率和发病率增加相关。关注早期SCr的小幅增加可能有助于结合其他新的阿基生物标志物进行早期阿基诊断。
In adults, small (< 50%) serum creatinine (SCr) increases predict mortality. It is unclear whether different baseline serum creatinine (bSCr) estimation methods affect findings of acute kidney injury (AKI)-outcome associations. We characterized pediatric AKI, evaluated the effect of bSCr estimation approaches on AKI-outcome associations and evaluated the use of small SCr increases to predict AKI development. We conducted a retrospective cohort database study of children (excluding postoperative cardiac or renal transplant patients) admitted to two pediatric intensive care units (PICUs) for at least one night in Montreal, QC, Canada. The AKI definition was based on the Acute Kidney Injury Network staging system, excluding the requirement of SCr increase within 48 hours, which was impossible to evaluate on the basis of our data set. We estimated bSCr two ways: (1) the lowest SCr level in the three months before admission or the average age- and gender-based norms (the standard method) or (2) by using average norms in all patients. Outcomes were PICU mortality and length of stay as well as required mechanical ventilation. We used multiple logistic regression analysis to evaluate AKI risk factors and the association between AKI and mortality. We used multiple linear regression analysis to evaluate the effect of AKI on other outcomes. We calculated diagnostic characteristics for early SCr increase (< 50%) to predict AKI development. Of 2,106 admissions (mean age ± SD = 5.0 ± 5.5 years; 47% female), 377 patients (17.9%) developed AKI (using the standard bSCr method) during PICU admission. Higher Pediatric Risk of Mortality score, required mechanical ventilation, documented infection and having a bSCr measurement were independent predictors of AKI development. AKI was associated with increased mortality (adjusted odds ratio (OR) = 3.7, 95% confidence interval (95% CI) = 2.1 to 6.4, using the standard bSCr method; OR = 4.5, 95% CI = 2.6 to 7.9, using normative bSCr values in all patients). AKI was independently associated with longer PICU stay and required mechanical ventilation. In children with no admission AKI, the initial percentage SCr increase predicted AKI development (area under the curve = 0.67, 95% CI = 0.60 to 0.74). AKI is associated with increased mortality and morbidity in critically ill children, regardless of the bSCr used. Paying attention to small early SCr increases may contribute to early AKI diagnosis in conjunction with other new AKI biomarkers.
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血浆中性粒细胞明胶酶相关的Lipocalin可预测小儿心脏手术后的急性肾脏损伤，发病率和死亡率：一项前瞻性不受控制的队列研究。
DOI：
10.1186/cc6192
发表时间：
2007
期刊：
Critical care (London, England)
影响因子：
--
作者：
Dent CL;Ma Q;Dastrala S;Bennett M;Mitsnefes MM;Barasch J;Devarajan P
通讯作者：
Devarajan P
急性肾脏损伤的步枪标准与重症患者的医院死亡率有关：一项队列分析。
影响因子：
15.1
作者：
Hoste, Eric A. J.;Clermont, Gilles;Kersten, Alexander;Venkataraman, Ramesh;Angus, Derek C.;De Bacquer, Dirk;Kellum, John A.
通讯作者：
Kellum, John A.
DOI：
10.1186/cc7032
发表时间：
2008
期刊：
Critical care (London, England)
影响因子：
--
作者：
Steinvall I;Bak Z;Sjoberg F
通讯作者：
Sjoberg F
影响因子：
19.6
作者：
Akcan-Arikan, A.;Zappitelli, M.;Goldstein, S. L.
通讯作者：
Goldstein, S. L.
DOI：
10.1186/cc6997
发表时间：
2008
期刊：
Critical care (London, England)
影响因子：
--
作者：
Lopes JA;Fernandes P;Jorge S;Gonçalves S;Alvarez A;Costa e Silva Z;França C;Prata MM
通讯作者：
Prata MM