重症监护室患儿心脏停搏后早期出现急性肾损伤的危险因素及预后分析

Risk factors for early acute kidney injury after cardiac arrest in children in the pediatric intensive care unit and a prognostic analysis

摘要:

目的 探讨心脏停搏（cardiac arrest，CA）患儿发生急性肾损伤（acute kidney injury，AKI）的相关因素及预后的影响因素。 方法 回顾性收集2016年6月—2021年6月湖南省儿童医院儿童重症监护室发生CA患儿的病历资料。按CA恢复自发循环（return of spontaneous circulation，ROSC）48 h内是否发生AKI分为AKI组（n=50）和非AKI组（n=113），AKI组按ROSC 7 d时预后情况分为存活组（n=21）和死亡组（n=29）。采用多因素logistic回归分析CA患儿早期发生AKI的相关因素及预后影响因素。 结果 CA后AKI发生率为30.7%（50/163）。AKI组7 d及28 d病死率分别为58.0%（29/50）、78.0%（39/50），非AKI组为31.9%（36/113）、58.4%（66/113）。多因素logistic回归分析显示，心肺复苏时间长（OR=1.164，95%CI：1.088~1.246，P<0.001）、基线血清白蛋白低（OR=0.879，95%CI：0.806~0.958，P=0.003）、CA前应用肾上腺素（OR=2.791，95%CI：1.119~6.961，P=0.028）与CA后AKI发生密切相关；基线小儿危重病例评分低（OR=0.761，95%CI：0.612~0.945，P=0.014）、CA前应用肾上腺素（OR=7.018，95%CI：1.196~41.188，P=0.031）、CA前机械通气（OR=7.875，95%CI：1.358~45.672，P=0.021）与CA后AKI患儿死亡密切相关。 结论 CA后ROSC患儿应密切监测血清白蛋白，尤其是心肺复苏时间长、基线小儿危重病例评分低、CA前应用肾上腺素、CA前机械通气者应及早识别和干预，以降低AKI发生率和病死率。

Abstract:

Objective To investigate the risk factors for acute kidney injury (AKI) in children with cardiac arrest (CA) and the influencing factors for prognosis. Methods A retrospective analysis was performed on the medical records of the children who developed CA in the pediatric intensive care unit (PICU) of Hunan Children's Hospital from June 2016 to June 2021. According to the presence or absence of AKI within 48 hours after return of spontaneous circulation (ROSC) for CA, the children were divided into two groups: AKI (n=50) and non-AKI (n=113). According to their prognosis on day 7 after ROSC, the AKI group was further divided into a survival group (n=21) and a death group (n=29). The multivariate logistic regression analysis was used to investigate the risk factors for early AKI in the children with CA and the influencing factors for prognosis. Results The incidence rate of AKI after CA was 30.7% (50/163). The AKI group had a 7-day mortality rate of 58.0% (29/50) and a 28-day mortality rate of 78.0% (39/50), and the non-AKI group had a 7-day mortality rate of 31.9% (36/113) and a 28-day mortality rate of 58.4% (66/113). The multivariate logistic regression analysis showed that long duration of cardiopulmonary resuscitation (OR=1.164, 95%CI: 1.088-1.246, P<0.001), low baseline albumin (OR=0.879, 95%CI: 0.806-0.958, P=0.003), and adrenaline administration before CA (OR=2.791, 95%CI: 1.119-6.961, P=0.028) were closely associated with the development of AKI after CA, and that low baseline pediatric critical illness score (OR=0.761, 95%CI: 0.612-0.945, P=0.014), adrenaline administration before CA (OR=7.018, 95%CI: 1.196-41.188, P=0.031), and mechanical ventilation before CA (OR=7.875, 95%CI: 1.358-45.672, P=0.021) were closely associated with the death of the children with AKI after CA. Conclusions Albumin should be closely monitored for children with ROSC after CA, especially for those with long duration of cardiopulmonary resuscitation, low baseline pediatric critical illness score, adrenaline administration before CA, and mechanical ventilation before CA, and such children should be identified and intervened as early as possible to reduce the incidence of AKI and the mortality rate.