The incidence of pediatric acute kidney injury is increased when identified by a change in a creatinine-based electronic alert
The incidence of pediatric acute kidney injury is increased when identified by a change in a creatinine-based electronic alert
复制标题
DOI：
10.1016/j.kint.2017.03.009
复制
发表时间：
2017-08-01
影响因子：
19.6
通讯作者：
Phillips, Aled O.
中科院分区：
文献类型：
--
作者：
Holmes, Jennifer;Roberts, Gethin;Phillips, Aled O.
我们开展了一项前瞻性国家队列研究，收集所有儿童（18岁以下）急性肾损伤（AKI）病例的数据，这些病例是通过威尔士国家电子AKI报告系统的生化电子警报识别的。在此，我们描述了使用KDIGO基于肌酐的系统数据集的这种修改来表征儿科AKI的实用性和局限性。在30个月的1343次事件中，34.5%发生在新生儿中，其中83.8%为AKI 1期。新生儿30天死亡率为4.1%，其中73.3%是在重症监护病房接受治疗的患者。在非新生儿组中，76.1%为AKI 1期。医院获得性AKI占40.1%，而社区获得性AKI占29.4%，其中33.9%住院，30.5%病例未分类。非新生儿30天死亡率为1.2%，其中一半是在重症监护病房接受治疗的患者。30天肾功能不恢复的发生率为28%，未住院患者的发生率明显更高（45%对20%）。报告的儿童AKI发生率远远高于先前依赖于成人AKI临床鉴定或医院编码数据的研究报告。新生儿死亡率最高，并受重症监护病房的影响。肾功能不恢复和持续性肾功能损害在非新生儿中更为常见，在未住院的社区获得性AKI患者中尤其高。
A prospective national cohort study was undertaken to collect data on all cases of pediatric (under 18 yrs of age) acute kidney injury (AKI) identified by a biochemistry-based electronic alert using the Welsh National electronic AKI reporting system. Herein we describe the utility and limitation of using this modification of the KDIGO creatinine-based system data set to characterize pediatric AKI. Of 1,343 incident episodes over a 30-month period, 34.5% occurred in neonates of which 83.8% were AKI stage 1. Neonatal 30-day mortality was 4.1%, with 73.3% of this being accounted for by patients treated in an Intensive Care Unit. In the non-neonatal group, 76.1% were AKI stage 1. Hospital-acquired AKI accounted for 40.1% of episodes while community-acquired AKI represented 29.4% of cases within which 33.9% were admitted to hospital and 30.5% of cases were unclassified. Non-neonatal 30-day mortality was 1.2%, with half of this accounted for by patients treated in the Intensive Care Unit. Nonrecovery of renal function at 30 days occurred in 28% and was significantly higher in patients not admitted to hospital (45% vs. 20%). The reported incidence of AKI in children was far greater than previously reported in studies reliant on clinical identification of adult AKI or hospital coding data. Mortality was highest in neonates and driven by those in the Intensive Care Unit. Nonrecovery of renal function and persistent renal impairment was more common in nonneonates and was especially high in patients with community-acquired AKI who were not hospitalized.