Objectives: 

Up to 37% of children admitted to the PICU develop acute kidney injury as defined by Kidney Disease: Improving Global Outcomes criteria. We describe the prevalence of acute kidney injury in a mixed pediatric intensive care cohort using this criteria. As tools to stratify patients at risk of acute kidney injury on PICU admission are lacking, we explored the variables at admission and day 1 that might predict the development of acute kidney injury.

Design: 

Single-center retrospective observational study.

Setting: 

Thirty-six–bed surgical/medical tertiary PICU.

Patients: 

Children from birth to less than or equal to 16 years old admitted between 2015 and 2018.

Interventions: 

None.

Measurements and Main Results: 

Clinical data were extracted from the PICU clinical information system. Patients with baseline creatinine at admission greater than 20 micromol/L above the calculated normal creatinine level were classified as “high risk of acute kidney injury.” Models were created to predict acute kidney injury at admission and on day 1. Out of the 7,505 children admitted during the study period, 738 patients (9.8%) were classified as high risk of acute kidney injury at admission and 690 (9.2%) developed acute kidney injury during PICU admission. Compared to Kidney Disease: Improving Global Outcomes criteria as the reference standard, high risk of acute kidney injury had a lower sensitivity and higher specificity compared with renal angina index greater than or equal to 8 on day 1. For the admission model, the adjusted odds ratio of developing acute kidney injury for high risk of acute kidney injury was 4.2 (95% CI, 3.3–5.2). The adjusted odds ratio in the noncardiac cohort for high risk of acute kidney injury was 7.3 (95% CI, 5.5–9.7). For the day 1 model, odds ratios for high risk of acute kidney injury and renal angina index greater than or equal to 8 were 3.3 (95% CI, 2.6–4.2) and 3.1 (95% CI, 2.4–3.8), respectively.

Conclusions: 

The relationship between high risk of acute kidney injury and acute kidney injury needs further evaluation. High risk of acute kidney injury performed better in the noncardiac cohort.

中文翻译：

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入院小儿重症监护病房对急性肾损伤的预测

目标： 

根据肾脏病：改善总体结果标准，多达37％的PICU入院儿童会出现急性肾损伤。我们使用此标准描述了混合型儿科重症监护队列中急性肾损伤的患病率。由于缺乏将PICU入院时有急性肾损伤风险的患者进行分层的工具，我们探讨了入院时和第1天的变量，这些变量可以预测急性肾损伤的发生。

设计： 

单中心回顾性观察研究。

设置： 

三十六张外科/医学三级PICU。

耐心： 

2015年至2018年之间，从出生到16岁以下的儿童入学。

干预措施： 

没有。

测量和主要结果： 

从PICU临床信息系统中提取临床数据。入院时基线肌酐高于计算的正常肌酐水平超过20微摩尔/升的患者被分类为“急性肾损伤的高风险”。创建了用于预测入院时和第1天的急性肾损伤的模型。在研究期间入院的7,505名儿童中，有738例（9.8％）被分类为入院时发生急性肾损伤的高风险，有690例（9.2％）被开发为入院PICU期间发生急性肾损伤。与肾脏疾病相比：以全球疗效标准为参考标准，急性肾损伤的高风险具有较低的灵敏度和更高的特异性与肾绞痛指数大于或等于8在第1天为接纳模型，开发的调整比值比相比急性肾损伤为高风险急性肾损伤为4.2（95％CI， 3.3–5.2）。在非心脏队列中，发生急性肾损伤的高风险的校正比值比为7.3（95％CI，5.5-9.7）。对于第1天模型，发生急性肾损伤高风险和肾绞痛指数大于或等于8的几率分别为3.3（95％CI，2.6-4.2）和3.1（95％CI，2.4-3.8）。

结论： 

高之间的关系的危险性急性肾损伤和急性肾损伤，需要进一步评估。在非心脏队列中，急性肾损伤的高风险表现更好。