Emma C Alexander, Romit Saxena, Raman Singla, Abdel Douiri, Akash Deep
{"title":"小儿急性肝衰竭中严重急性肾损伤的患病率、相关因素和预后：单中心回顾性研究，2003-2017 年。","authors":"Emma C Alexander, Romit Saxena, Raman Singla, Abdel Douiri, Akash Deep","doi":"10.1097/PCC.0000000000003547","DOIUrl":null,"url":null,"abstract":"<p><strong>Objectives: </strong>Our aim was to determine the prevalence and explanatory factors associated with outcomes in children with acute liver failure (ALF) admitted to the PICU, who also develop severe acute kidney injury (AKI).</p><p><strong>Design: </strong>Retrospective cohort, 2003 to 2017.</p><p><strong>Setting: </strong>Sixteen-bed PICU in a university-affiliated tertiary care hospital.</p><p><strong>Patients: </strong>Admissions to the PICU with ALF underwent data review of the first week and at least 90-day follow-up. Patients with stages 2-3 AKI using the British Association of pediatric Nephrology definitions, or receiving continuous renal replacement therapy (CRRT) for renal indications, were defined as severe AKI. We excluded ALF cases on CRRT for hepatic-only indications.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Baseline characteristics, proportion with severe AKI, illness severity and interventions, and outcomes (i.e., transplant, survival with native liver, overall survival, duration of PICU stay, and mechanical ventilation). Ninety-four children with ALF admitted to the PICU were included. Over the first week, 29 had severe AKI, and another eight received CRRT for renal/mixed reno-hepatic indications; hence, the total severe AKI cohort was 37 of 94 (39.4%). In a multivariable logistic regression model, peak aspartate aminotransferase (AST) and requirement for inotropes on arrival were associated with severe AKI. Severe AKI was associated with longer PICU stay and duration of ventilation, and lower spontaneous survival with native liver. In another model, severe AKI was associated with greater odds of mortality (odds ratio 7.34 [95% CI, 1.90-28.28], p = 0.004). After 90 days, 3 of 17 survivors of severe AKI had serum creatinine greater than the upper limit of normal for age.</p><p><strong>Conclusions: </strong>Many children with ALF in the PICU develop severe AKI. Severe AKI is associated with the timecourse of PICU admission and outcome, including survival with native liver. Future work should look at ALF goal directed renoprotective strategies at the time of presentation.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":null,"pages":null},"PeriodicalIF":4.0000,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Prevalence, Associated Factors, and Outcomes of Severe Acute Kidney Injury in Pediatric Acute Liver Failure: Single-Center Retrospective Study, 2003-2017.\",\"authors\":\"Emma C Alexander, Romit Saxena, Raman Singla, Abdel Douiri, Akash Deep\",\"doi\":\"10.1097/PCC.0000000000003547\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objectives: </strong>Our aim was to determine the prevalence and explanatory factors associated with outcomes in children with acute liver failure (ALF) admitted to the PICU, who also develop severe acute kidney injury (AKI).</p><p><strong>Design: </strong>Retrospective cohort, 2003 to 2017.</p><p><strong>Setting: </strong>Sixteen-bed PICU in a university-affiliated tertiary care hospital.</p><p><strong>Patients: </strong>Admissions to the PICU with ALF underwent data review of the first week and at least 90-day follow-up. Patients with stages 2-3 AKI using the British Association of pediatric Nephrology definitions, or receiving continuous renal replacement therapy (CRRT) for renal indications, were defined as severe AKI. We excluded ALF cases on CRRT for hepatic-only indications.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Baseline characteristics, proportion with severe AKI, illness severity and interventions, and outcomes (i.e., transplant, survival with native liver, overall survival, duration of PICU stay, and mechanical ventilation). Ninety-four children with ALF admitted to the PICU were included. Over the first week, 29 had severe AKI, and another eight received CRRT for renal/mixed reno-hepatic indications; hence, the total severe AKI cohort was 37 of 94 (39.4%). In a multivariable logistic regression model, peak aspartate aminotransferase (AST) and requirement for inotropes on arrival were associated with severe AKI. Severe AKI was associated with longer PICU stay and duration of ventilation, and lower spontaneous survival with native liver. In another model, severe AKI was associated with greater odds of mortality (odds ratio 7.34 [95% CI, 1.90-28.28], p = 0.004). After 90 days, 3 of 17 survivors of severe AKI had serum creatinine greater than the upper limit of normal for age.</p><p><strong>Conclusions: </strong>Many children with ALF in the PICU develop severe AKI. Severe AKI is associated with the timecourse of PICU admission and outcome, including survival with native liver. Future work should look at ALF goal directed renoprotective strategies at the time of presentation.</p>\",\"PeriodicalId\":19760,\"journal\":{\"name\":\"Pediatric Critical Care Medicine\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":4.0000,\"publicationDate\":\"2024-08-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Pediatric Critical Care Medicine\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1097/PCC.0000000000003547\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/6/7 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q1\",\"JCRName\":\"CRITICAL CARE MEDICINE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Pediatric Critical Care Medicine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/PCC.0000000000003547","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/6/7 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"CRITICAL CARE MEDICINE","Score":null,"Total":0}
引用次数: 0
摘要
目的我们的目的是确定入住重症监护病房（PICU）的急性肝功能衰竭（ALF）患儿中同时出现严重急性肾损伤（AKI）的患儿的患病率及其与治疗结果相关的解释性因素：设计：回顾性队列，2003年至2017年：地点：一所大学附属三级医院的 16 张病床的 PICU：PICU收治的ALF患者均接受了第一周的数据回顾和至少90天的随访。根据英国儿科肾脏病学会的定义，AKI 为 2-3 期的患者或因肾脏疾病接受持续肾脏替代治疗 (CRRT) 的患者被定义为重度 AKI。我们排除了仅因肝脏适应症而接受CRRT的ALF病例：干预措施：无：基线特征、重度 AKI 比例、病情严重程度和干预措施以及结果（即移植、原肝存活率、总存活率、PICU 住院时间和机械通气）。在第一周内，有29名患儿出现了严重的AKI，另有8名患儿因肾脏/肝肾混合适应症接受了CRRT治疗；因此，在94名患儿中，有37名患儿出现了严重的AKI（39.4%）。在多变量逻辑回归模型中，天门冬氨酸氨基转移酶（AST）峰值和到达时肌注需求与严重 AKI 相关。重度 AKI 与更长的 PICU 住院时间和通气时间以及更低的原肝自发存活率有关。在另一个模型中，重度 AKI 与更高的死亡几率相关（几率比 7.34 [95% CI, 1.90-28.28]，P = 0.004）。90天后，17名重度AKI幸存者中有3人的血清肌酐超过了年龄的正常上限：结论：PICU中的许多ALF患儿会出现严重的AKI。结论：PICU中的许多ALF患儿都会出现严重的AKI，严重的AKI与PICU的入院时间和预后有关，包括原肝存活率。未来的工作应着眼于ALF发病时的肾保护目标策略。
Prevalence, Associated Factors, and Outcomes of Severe Acute Kidney Injury in Pediatric Acute Liver Failure: Single-Center Retrospective Study, 2003-2017.
Objectives: Our aim was to determine the prevalence and explanatory factors associated with outcomes in children with acute liver failure (ALF) admitted to the PICU, who also develop severe acute kidney injury (AKI).
Design: Retrospective cohort, 2003 to 2017.
Setting: Sixteen-bed PICU in a university-affiliated tertiary care hospital.
Patients: Admissions to the PICU with ALF underwent data review of the first week and at least 90-day follow-up. Patients with stages 2-3 AKI using the British Association of pediatric Nephrology definitions, or receiving continuous renal replacement therapy (CRRT) for renal indications, were defined as severe AKI. We excluded ALF cases on CRRT for hepatic-only indications.
Interventions: None.
Measurements and main results: Baseline characteristics, proportion with severe AKI, illness severity and interventions, and outcomes (i.e., transplant, survival with native liver, overall survival, duration of PICU stay, and mechanical ventilation). Ninety-four children with ALF admitted to the PICU were included. Over the first week, 29 had severe AKI, and another eight received CRRT for renal/mixed reno-hepatic indications; hence, the total severe AKI cohort was 37 of 94 (39.4%). In a multivariable logistic regression model, peak aspartate aminotransferase (AST) and requirement for inotropes on arrival were associated with severe AKI. Severe AKI was associated with longer PICU stay and duration of ventilation, and lower spontaneous survival with native liver. In another model, severe AKI was associated with greater odds of mortality (odds ratio 7.34 [95% CI, 1.90-28.28], p = 0.004). After 90 days, 3 of 17 survivors of severe AKI had serum creatinine greater than the upper limit of normal for age.
Conclusions: Many children with ALF in the PICU develop severe AKI. Severe AKI is associated with the timecourse of PICU admission and outcome, including survival with native liver. Future work should look at ALF goal directed renoprotective strategies at the time of presentation.
期刊介绍：
Pediatric Critical Care Medicine is written for the entire critical care team: pediatricians, neonatologists, respiratory therapists, nurses, and others who deal with pediatric patients who are critically ill or injured. International in scope, with editorial board members and contributors from around the world, the Journal includes a full range of scientific content, including clinical articles, scientific investigations, solicited reviews, and abstracts from pediatric critical care meetings. Additionally, the Journal includes abstracts of selected articles published in Chinese, French, Italian, Japanese, Portuguese, and Spanish translations - making news of advances in the field available to pediatric and neonatal intensive care practitioners worldwide.
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