BACKGROUND Acute kidney injury (AKI) that improves in the pediatric intensive care unit (PICU) is associated with better outcomes compared to AKI that persists, but no study has investigated whether this also occurs in children undergoing cardiopulmonary bypass (CPB). METHODS A retrospective study of children ≤18 years who underwent CPB in three children's hospitals was conducted. Patients were classified into groups by kidney recovery after AKI according to Acute Disease Quality Initiative (ADQI) guidelines. Adjusted regression models evaluated associations between kidney recovery group and hospital outcomes. RESULTS Among 3620 children, AKI developed in 701 (19.4%): 610 transient AKI, 47 persistent AKI, and 44 acute kidney disease (AKD). Mortality increased with severity of kidney recovery group: 4.5% in the never developed AKI group, 8.9% in the transient AKI group, 25.5% in the persistent AKI group, and 31.8% in the AKD group (p <0.0001). In adjusted analysis, transient AKI (HR 1.4, CI 1.02, 2), persistent AKI (HR 22.4, CI 10.2, 49.2), and AKD (HR 3.7, CI 1.7, 7.9) had a greater hazard of mortality when compared to the never developed AKI group. Patients with transient AKI had a longer length of PICU stay than those with never developed AKI (HR 5.1, CI 2.9, 7.3). CONCLUSIONS Patterns of kidney recovery after AKI were associated with worse PICU outcomes in children after CPB compared to those who did not develop AKI, even after rapid AKI recovery. Identification of factors that increase risk for these AKI patterns is necessary for prevention of AKI during CPB in children. A higher resolution version of the Graphical abstract is available as Supplementary information.

中文翻译：

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儿童体外循环后急性肾损伤和肾脏恢复。

背景与持续存在的 AKI 相比，在儿科重症监护病房 (PICU) 中改善的急性肾损伤 (AKI) 与更好的结果相关，但没有研究调查这是否也发生在接受体外循环 (CPB) 的儿童中。方法对在三所儿童医院接受CPB的≤18岁儿童进行回顾性研究。根据急性疾病质量倡议 (ADQI) 指南，根据 AKI 后的肾脏恢复情况对患者进行分组。调整后的回归模型评估了肾脏恢复组与医院结果之间的关联。结果 在 3620 名儿童中，701 名 (19.4%) 发生 AKI：610 名短暂性 AKI、47 名持续性 AKI 和 44 名急性肾病 (AKD)。死亡率随着肾脏恢复组的严重程度而增加：从未发生 AKI 组中为 4.5%，8。短暂性 AKI 组为 9%，持续性 AKI 组为 25.5%，AKD 组为 31.8%（p <0.0001）。在调整后的分析中，与从未发生过相比，短暂性 AKI (HR 1.4, CI 1.02, 2)、持续性 AKI (HR 22.4, CI 10.2, 49.2) 和 AKD (HR 3.7, CI 1.7, 7.9) 具有更大的死亡风险开发了 AKI 组。与从未发生 AKI 的患者相比，患有短暂性 AKI 的患者在 PICU 停留的时间更长（HR 5.1，CI 2.9，7.3）。结论 与未发生 AKI 的儿童相比，即使在 AKI 快速恢复后，AKI 后肾脏恢复模式与 CPB 后儿童 PICU 结局较差相关。确定增加这些 AKI 模式风险的因素对于预防儿童 CPB 期间的 AKI 是必要的。图形摘要的更高分辨率版本可作为补充信息。