| Objective:Analyze the distribution of etiology of acute renal injury(AKI)in hospitalized children of different age groups and explore the risk factors affecting the prognosis of children with AKI.To take timely intervention measures to prevent the occurrence of AKI or control the further development of AKI in hospitalized children to improve the prognosis of children with AKI.Methods:This study retrospectively analyzed the children who underwent two or more renal function tests during hospitalization in Jiangxi Children’s Hospital from January1,2018 to December 31,2019.The minimum value of serum creatinine during hospitalization was taken as the baseline value of creatinine,and the maximum value of serum creatinine was taken as the peak value.According to the definition in the Clinical Practice Guide for AKI published by the Kidney Disease:Improving Global Outcomes,KDIGO in 2012,The clinical data of children whose serum creatinine increased 0.3mg/dl(≥26.5μmol/L)within 48 hours or increased to 1.5 times or more than 1.5 times of baseline creatinine within 7 days were collected.According to the inclusion and exclusion criteria,440 children with AKI were included in this study.The clinical data of children with AKI were collected,including general information:hospitalization number,sex,age,length of hospitalization,hospitalization department,hospitalization expenses;medical history information:etiology,mechanical ventilation,concomitant disease,discharge;laboratory examination indicators:blood creatinine value,urine red blood cell,urine protein,white blood cell,red blood cell,platelet and so on.According to the etiology,the children were divided into three groups:pre-renal group renal group and post-renal group.According to the age,the children were divided into five groups:neonatal group(≤28 days),infant group(29days～1years old),toddler group(1～3 years old),preschool group(3～7years old)and school age group(>7 years old).Taking the time of discharge as the cutoff point,the children were divided into two groups:good prognosis(including recovery and improvement)and poor prognosis(ineffective).The data were analyzed by statistical software SPSS26.0.The measurement data with normal distribution and uniform variance were expressed by mean?standard deviation(?x?s),otherwise they were expressed by quartile range(QR)and median(M).Chi-square test was used to compare the constituent ratio or rate of counting data.Multivariate Logistic regression(enter)was used to analyze the risk factors affecting the prognosis of children with AKI.It is statistically significant to set P<0.05 as the difference.Results:1.Clinical characteristics of children with AKI:Among the 440 cases,there were 257 males(58.41%)and 183 females(41.59%).Age composition:neonatal group 70 cases(15.91%),infant group 102cases(23.18%),toddler group 97 cases(22.05%),preschool group 76 cases(17.27%),school age group 95 cases(21.59%).Etiological composition:there were 323 cases of pre-renal AKI(73.41%),the most common was AKI related to infection and cardiovascular system diseases,105 cases(23.86%)were renal AKI,the most common was AKI caused by nephrotoxic drugs,12 cases(2.73%)were post-renal AKI,and AKI caused by urinary calculi was the most common.2.Distribution characteristics of etiology in different age groups:Etiological composition of each age group:Neonatal group:pre-renal 65 cases(14.77%),renal 5 cases(1.14%),post-renal 0 cases(0.00%);infant group:pre-renal98 cases(22.27%),renal 2 cases(0.45%),post-renal 2 cases(0.45%);toddler group:pre-renal 77 cases(17.50%),renal 16 cases(3.64%),post-renal 4 cases(0.91%).preschool group:pre-renal 41 cases(9.32%),renal 31 cases(7.05%),post-renal 4case(0.91%);school age group:pre-renal 42 cases(9.55%),renal 51 cases(11.59%),post-renal 2 cases(0.45%).Through chi-square test,it was found that there were significant differences in the distribution of different causes in different age groups(X~2=72.279,P<0.05).3.prognosis of children with acute kidney injury:According to the time of discharge,the children with AKI were divided into two groups:good prognosis group and poor prognosis group.The good prognosis group included 353 cases(80.23%)in the recovery group and the improvement group,and87 cases(19.77%)in the poor prognosis group.Multivariate Logistic regression(enter method)was used to analyze the risk factors affecting prognosis.The results of multivariate logistic regression analysis showed that mechanical ventilation(OR=0.120;95%CI:0.056～0.259),sepsis(OR=0.062;95%CI:0.028～0.138)and multiple organ dysfunction syndrome(OR=0.024;95%CI:0.006～0.095)were independent risk factors for the prognosis of children with AKI.Conclusion:The main etiology of AKI in children is prerenal,and the occurrence of renal AKI increases with the age of children.The main etiology of pediatric AKI:infection and cardiovascular system related diseases.Mechanical ventilation,sepsis and multiple organ dysfunction syndrome are independent risk factors affecting the prognosis of hospitalized children with AKI. |
PDF Full Text Request