Acute Kidney Injury Is Common in Pediatric Severe Malaria and Is Associated With Increased Mortality.
Acute Kidney Injury Is Common in Pediatric Severe Malaria and Is Associated With Increased Mortality.
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急性肾脏损伤在小儿严重疟疾中很常见，与死亡率升高有关。
DOI：
10.1093/ofid/ofw046
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发表时间：
2016-03
影响因子：
4.2
通讯作者：
Kain KC
中科院分区：
文献类型：
--
作者：
Conroy AL;Hawkes M;Elphinstone RE;Morgan C;Hermann L;Barker KR;Namasopo S;Opoka RO;John CC;Liles WC;Kain KC
急性肾损伤在严重疟疾中很常见，50% 的病例入院后会出现短期和长期死亡。胱抑素 C 和 BUN 与 AKI 的严重程度相关，入院时升高并预测死亡率。背景。 急性肾损伤 (AKI) 是成人严重疟疾的一种公认的并发症，但 AKI 在儿童严重疟疾 (SM) 中的发病率和临床重要性尚无充分记录。方法。 2011 年至 2013 年间，乌干达招募了 180 名 1 至 10 岁的 SM 儿童。使用血清肌酐 (Cr) 每天监测肾功能，持续 4 天。急性肾损伤是根据肾脏疾病：改善全球成果 (KDIGO) 指南定义的。使用 i-STAT 评估血尿素氮 (BUN) 和 Cr，并通过酶联免疫吸附测定法测量胱抑素 C (CysC)。结果。 研究中 81 名 (45.5%) 儿童患有 KDIGO 定义的 AKI：42 名 (51.9%) 1 期儿童、18 名 (22.2%) 2 期儿童和 21 名 (25.9%) 3 期儿童。入院后，50% 的儿童出现或发展为急性肾损伤。随机接受吸入一氧化氮 (iNO) 的儿童发生 AKI 的风险增加，iNO 组中有 47 名儿童 (54.0%) 发生 AKI，而安慰剂组有 34 名儿童 (37.4%) 发生 AKI（相对风险，1.36；95% 置信区间 [CI]，1.03–1.80）。不同 AKI 阶段的住院时间均有所增加 (P = .002)。接受安慰剂的儿童中，急性肾损伤与出院时的神经功能障碍相关（患有 AKI 的儿童为 25%，无 AKI 的儿童为 1.9%，P = 0.002）。安慰剂组中 AKI 各阶段的死亡率均有所增加 (P = .006)，在 AKI 3 阶段死亡率达到 37.5%。接受 iNO 治疗的儿童的急性肾损伤与出院时的神经功能障碍或死亡率无关（两者 P > 0.05）。肾脏生物标志物水平可预测死亡率，曲线下面积 (AUC) 分别为 0.80 (95% CI, .65–.95; P = .006) 和 0.72 (95% CI, .57–.87; P < .001)。 6 个月前死亡的儿童入院时 CysC 和 BUN 水平升高（分别为 P < .0001 和 P = .009）。结论。 急性肾损伤是 SM 幼儿的一种未被充分认识的并发症，并且与死亡率增加相关。
Acute kidney injury is common in severe malaria and associated with short- and long-term mortality developing in 50% of cases after admission. Cystatin C and BUN are associated with the severity of AKI, are elevated at admission and predict mortality. Background. Acute kidney injury (AKI) is a well recognized complication of severe malaria in adults, but the incidence and clinical importance of AKI in pediatric severe malaria (SM) is not well documented. Methods. One hundred eighty children aged 1 to 10 years with SM were enrolled between 2011 and 2013 in Uganda. Kidney function was monitored daily for 4 days using serum creatinine (Cr). Acute kidney injury was defined using the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines. Blood urea nitrogen (BUN) and Cr were assessed using i-STAT, and cystatin C (CysC) was measured by enzyme-linked immunosorbent assay. Results. Eighty-one (45.5%) children had KDIGO-defined AKI in the study: 42 (51.9%) stage 1, 18 (22.2%) stage 2, and 21 (25.9%) stage 3. Acute kidney injury evolved or developed in 50% of children after admission of hospital. There was an increased risk of AKI in children randomized to inhaled nitric oxide (iNO), with 47 (54.0%) of children in the iNO arm developing AKI compared with 34 (37.4%) in the placebo arm (relative risk, 1.36; 95% confidence interval [CI], 1.03–1.80). Duration of hospitalization increased across stages of AKI (P = .002). Acute kidney injury was associated with neurodisability at discharge in the children receiving placebo (25% in children with AKI vs 1.9% in children with no AKI, P = .002). Mortality increased across stages of AKI (P = .006) in the placebo arm, reaching 37.5% in stage 3 AKI. Acute kidney injury was not associated with neurodisability or mortality at discharge in children receiving iNO (P > .05 for both). Levels of kidney biomarkers were predictive of mortality with areas under the curves (AUCs) of 0.80 (95% CI, .65–.95; P = .006) and 0.72 (95% CI, .57–.87; P < .001), respectively. Admission levels of CysC and BUN were elevated in children who died by 6 months (P < .0001 and P = .009, respectively). Conclusions. Acute kidney injury is an underrecognized complication in young children with SM and is associated with increased mortality.