Comparison of diagnostic criteria for acute kidney injury in critically ill children: a multicenter cohort study.
Comparison of diagnostic criteria for acute kidney injury in critically ill children: a multicenter cohort study.
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DOI：
10.1186/s13054-022-04083-0
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发表时间：
2022-07-07
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在定义急性肾损伤（阿基）和基线血清肌酐（SCr）方面存在显著的研究间异质性。本研究评估了不同阿基和基线SCr定义下的阿基发生率及其与儿科重症监护室（PICU）死亡率的相关性，以确定诊断儿科阿基的首选方法。在这项多中心前瞻性观察性队列研究中，根据肾脏疾病：改善总体结局（KDIGO）、改良KDIGO和针对阿基（pROCK）定义优化的儿科参考变化值对阿基进行定义和分期。根据Schwartz公式计算基线SCr或估计为标准化上限值（NormsMax）、入院SCr（AdmSCr）和改良AdmSCr。评估不同阿基定义和基线SCr估计方法对阿基发生率、严重程度分布和阿基结局的影响。 不同的阿基定义和基线SCr估计值导致阿基发生率差异，从6.8%到25.7%;所有定义的阿基患者的PICU死亡率较高，范围为19.0%至35.4%。根据KDIGO定义，基于Schwartz观察到阿基发生率较高（25.7%），但死亡率较低（19.0%），但改良KDIGO克服了这一点（阿基发生率：16.3%，PICU死亡率：26.1%）。此外，对于改良KDIGO，不同基线SCr估计方法之间的阿基分期一致性均较强，一致率> 90.0%，加权kappa值> 0.8，PICU死亡率根据Schwartz分期增加。当使用NormsMax时，KDIGO和改良KDIGO导致相同的阿基发生率（13.6%），但PICU死亡率在阿基分期之间没有差异。对于pROCK，PICU死亡率没有根据分期增加，阿基3期与调整混杂因素后的死亡率无关。阿基发生率和分期取决于定义和所用的基线SCr估计方法。基于Schwartz方法的改良KDIGO定义导致阿基与PICU死亡率高度相关，这表明它可能是诊断危重儿童阿基的首选方法，并为提高临床医生诊断儿科阿基的能力提供了希望。在线版本包含补充材料，可通过10.1186/s13054-022-04083-0获得。
Substantial interstudy heterogeneity exists in defining acute kidney injury (AKI) and baseline serum creatinine (SCr). This study assessed AKI incidence and its association with pediatric intensive care unit (PICU) mortality under different AKI and baseline SCr definitions to determine the preferable approach for diagnosing pediatric AKI. In this multicenter prospective observational cohort study, AKI was defined and staged according to the Kidney Disease: Improving Global Outcome (KDIGO), modified KDIGO, and pediatric reference change value optimized for AKI (pROCK) definitions. The baseline SCr was calculated based on the Schwartz formula or estimated as the upper normative value (NormsMax), admission SCr (AdmSCr) and modified AdmSCr. The impacts of different AKI definitions and baseline SCr estimation methods on AKI incidence, severity distribution and AKI outcome were evaluated. Different AKI definitions and baseline SCr estimates led to differences in AKI incidence, from 6.8 to 25.7%; patients with AKI across all definitions had higher PICU mortality ranged from 19.0 to 35.4%. A higher AKI incidence (25.7%) but lower mortality (19.0%) was observed based on the Schwartz according to the KDIGO definition, which however was overcome by modified KDIGO (AKI incidence: 16.3%, PICU mortality: 26.1%). Furthermore, for the modified KDIGO, the consistencies of AKI stages between different baseline SCr estimation methods were all strong with the concordance rates > 90.0% and weighted kappa values > 0.8, and PICU mortality increased pursuant to staging based on the Schwartz. When the NormsMax was used, the KDIGO and modified KDIGO led to an identical AKI incidence (13.6%), but PICU mortality did not differ among AKI stages. For the pROCK, PICU mortality did not increase pursuant to staging and AKI stage 3 was not associated with mortality after adjustment for confounders. The AKI incidence and staging vary depending on the definition and baseline SCr estimation method used. The modified KDIGO definition based on the Schwartz method leads AKI to be highly relevant to PICU mortality, suggesting that it may be the preferable approach for diagnosing AKI in critically ill children and provides promise for improving clinicians’ ability to diagnose pediatric AKI. The online version contains supplementary material available at 10.1186/s13054-022-04083-0.
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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：
19.6
作者：
Holmes, Jennifer;Roberts, Gethin;Phillips, Aled O.
通讯作者：
Phillips, Aled O.
影响因子：
3.6
作者：
Kuai, Yuxian;Huang, Hui;Li, Yanhong
通讯作者：
Li, Yanhong
影响因子：
26.1
作者：
Downes, Kevin J.;Cowden, Carter;Zaoutis, Theoklis E.
通讯作者：
Zaoutis, Theoklis E.
影响因子：
38.9
作者：
Barhight, Matthew F.;Brinton, John;Gist, Katja M.
通讯作者：
Gist, Katja M.