共查询到20条相似文献,搜索用时 0 毫秒
1.
2.
Nilzete Bresolin Carlos Silva Ana Halllal Julio Toporovski Vera Fernandes Jose Góes Francisca Ligia Carvalho 《Pediatric nephrology (Berlin, Germany)》2009,24(3):537-544
To define factors of prognostic importance for critically ill infants and children with acute kidney injury (AKI), we have studied 110 children, ages from 1 month to 180 months, admitted between March 1, 2002 and September 30, 2004 to the intensive care unit of Joana de Gusmão Children’s Hospital. These patients represent 8% of all intensive care unit admissions during the entire study period. The diagnosis at admission was primary renal parenchyma disease (eight patients, 7.2%) and secondary renal disease (102 patients, 92.8%). Thirty-seven patients (33.6%) died, all of whom had secondary renal insufficiency; six patients (5.4%) died as a result of septic shock, and 31 (28.2%) patients died from multiple organ failure (MOF). The variables were analyzed using Fisher’s exact test for qualitative variables and Student’s t-test for quantitative variables. Stratified analysis was performed to assess the relative importance of variables using the Mantel–Haenszel technique. Among the variables analyzed, the following were found to be significantly related to mortality: anuria, oliguria, arterial hypotension, need for pressor drugs, need for mechanical ventilation, need for dialysis, the association with MOF, and high values of lactic acid. 相似文献
3.
Background
A high incidence of hypernatremia is often observed in patients recovering from acute kidney injury (AKI) in intensive care units. 相似文献4.
5.
6.
7.
Nilzete Bresolin Aline Patrícia Bianchini Clarissa Alberton Haas 《Pediatric nephrology (Berlin, Germany)》2013,28(3):485-492
Background
In this study we applied the pediatric version of the RIFLE criteria (pRIFLE) to an at-risk hospital population, analyzed the incidence and association of acute kidney injury (AKI) with mortality and length of stay in both the intensive care unit (ICU) and the hospital, and evaluated the applicability of pRIFLE as a prognostic tool in the ICU.Methods
This study was a prospective single-center cohort study in which 126 patients were enrolled. The affected group included patients who were diagnosed with AKI. Subgroups of the diagnosed patients were established according to their maximum pRIFLE strata, which were defined as the worst pRIFLE score attained during the study period.Results
Fifty-eight (46 %) of our patients developed AKI. The lengths of stay in the ICU and in the hospital were longer in the affected group than in the unaffected group. The advanced strata of pRIFLEmax were associated with longer stays in the ICU and hospital and higher median Pediatric Index of Mortality II scores. The hospital mortality rate of AKI patients was 12-fold higher than that of the patients without AKI (36 vs. 3 %).Conclusion
The incidence of AKI in this population was both significant and directly associated with hospital mortality and the length of stay in the ICU and hospital. The pRIFLE classification facilitated the definition of AKI, indicating that it a significant prognostic predictor. 相似文献8.
Fen Jiang Jie Lei Jiaxuan Xiang Yuanhan Chen Jingsheng Feng Wenhe Xu Jihong Ou Bo Yang Li Zhang 《Renal failure》2022,44(1):1004
Monocyte-to-lymphocyte ratio (MLR) and neutrophil-to-lymphocyte ratio (NLR) are considered as surrogate inflammatory indexes. Previous studies indicated that NLR was associated with the development of septic acute kidney injury (AKI). The objective of the present study was to explore the value of MLR and NLR in the occurrence of AKI in intensive care unit (ICU) patients. The clinical details of adult patients (n = 1500) who were admitted to the ICU from January 2016 to December 2019 were retrospectively examined. AKI was diagnosed according to the Kidney Disease: Improving Global Outcomes criteria. The development of AKI was the main outcome, and the secondary outcome was in-hospital mortality. Overall, 615 (41%) patients were diagnosed with AKI. Both MLR and NLR were positively correlated with AKI incidence (p < 0.001). Multivariate logistic regression analysis suggested that the risk value of MLR for the occurrence of AKI was nearly three-fold higher than NLR (OR = 3.904, 95% CI: 1.623‒9.391 vs. OR = 1.161, 95% CI: 1.135‒1.187, p < 0.001). The areas under the receiver operating characteristic curve (AUC) for MLR and NLR in the prediction of AKI incidence were 0.899 (95% CI: 0.881‒0.917) and 0.780 (95% CI: 0.755‒0.804) (all p < 0.001), with cutoff values of 0.693 and 12.4. However, the AUC of MLR and NLR in the prediction of in-hospital mortality was 0.583 (95% CI: 0.546‒0.620, p < 0.001) and 0.564 (95% CI: 0.528‒0.601, p = 0.001). MLR, an inexpensive and widely available parameter, is a reliable biomarker in predicting the occurrence of AKI in ICU patients. 相似文献
9.
Akcan-Arikan A Zappitelli M Loftis LL Washburn KK Jefferson LS Goldstein SL 《Kidney international》2007,71(10):1028-1035
A classification system has been proposed to standardize the definition of acute kidney injury in adults. These criteria of risk, injury, failure, loss, and end-stage renal disease were given the acronym of RIFLE. We have modified the criteria based on 150 critically ill pediatric RIFLE (pRIFLE) patients to assess acute kidney injury incidence and course along with renal and/or non-renal comorbidities. Of these children, 11 required dialysis and 24 died. Patients without acute kidney injury in the first week of intensive care admission were less likely to subsequently develop renal Injury or Failure; however, 82% of acute kidney injury occurred in this initial week. Within this group of 123 children, 60 reached pRIFLEmax for Risk, 32 reached Injury, and 31 reached Failure. Acute kidney injury during admission was an independent predictor of intensive care; hospital length of stay and an increased risk of death independent of the Pediatric Risk of Mortality (PRISM II) score (odds ratio 3.0). Our results show that a majority of critically ill children develop acute kidney injury by pRIFLE criteria and do so early in the course of intensive care. Acute kidney injury is associated with mortality and may lead to increased hospital costs. We suggest that the pRIFLE criteria serves to characterize the pattern of acute kidney injury in critically ill children. 相似文献
10.
Comparison between early and delayed acute kidney injury secondary to infectious disease in the intensive care unit 总被引:2,自引:1,他引:1
Lima RS Marques CN Silva Júnior GB Barbosa AS Barbosa ES Mota RM Araújo SM Gutiérrez-Adrianzén OA Libório AB Daher EF 《International urology and nephrology》2008,40(3):731-739
BACKGROUND: Results from a number of studies suggest that the delayed manifestation of acute kidney injury (AKI) is associated with higher in-hospital mortality, while other studies were unable to demonstrate any difference among early and delayed AKI in terms of in-hospital mortality. OBJECTIVE: The aim of this study was to investigate differences in outcome among patients with AKI upon admission to an intensive care unit (ICU) and those who develop AKI post-admission. METHODS: We studied patients with AKI secondary to infectious diseases admitted to the ICU. We retrospectively compared data on patients admitted with AKI (early AKI) with data on those who developed AKI 24 h after admission (delayed AKI). RESULTS: Acute kidney injury occurred in 147 of 829 (17.7%) patients admitted to the ICU. Of these, 96 (65%) had early AKI and 51 (35%) had delayed AKI. Renal failure was classified according to RIFLE criteria-an AKI-specific severity score that is used to place patients into one of five categories: risk, injury, failure, loss or end-stage renal disease. Based on these criteria, 6% of the early AKI and 4% of the delayed AKI patients were in risk category, 18% of the early AKI and 27% of the delayed AKI patients were in the injury category and 76% of the early AKI and 69% of the delayed AKI patients were in the failure category. We found no significant association between RIFLE and death. On admission, patients with early AKI had statistically significantly higher serum urea and creatinine levels than delayed AKI patients (P < 0.0001). Arterial bicarbonate was lower in early AKI (P = 0.02). Sepsis, hypotension and use of mechanical ventilation were more frequent in delayed AKI (P < 0.05). The APACHE II score was higher in early AKI (P = 0.05) patients. In total, 98 (66.7%) patients died, with a tendency towards higher mortality in patients with delayed AKI (61.5 vs. 76.5%, P = 0.07). CONCLUSION: Mortality among patients with infectious diseases-associated AKI admitted to the ICU is high, with a trend to be higher in those who developed delayed AKI. 相似文献
11.
Sodium modelling to reduce intradialytic hypotension during haemodialysis for acute kidney injury in the intensive care unit
下载免费PDF全文
![点击此处可从《Nephrology (Carlton, Vic.)》网站下载免费的PDF全文](/ch/ext_images/free.gif)
Katherine E. Lynch Fatimah Ghassemi Jennifer E. Flythe Mengling Feng Marzyeh Ghassemi Leo Anthony Celi Steven M. Brunelli 《Nephrology (Carlton, Vic.)》2016,21(10):870-877
12.
13.
Hiroshi Morimatsu Yuichiro Toda Moritoki Egi Kazuyoshi Shimizu Takashi Matsusaki Satoshi Suzuki Tatsuo Iwasaki Kiyoshi Morita 《Journal of anesthesia》2009,23(3):334-340
Purpose We aimed to clarify the acid-base abnormalities of patients with acute kidney injury (AKI) requiring peritoneal dialysis (PD)
in pediatric cardiac care units.
Methods A retrospective observational study was conducted in a pediatric cardiac care unit in a tertiary care university hospital.
The subjects were 40 patients with AKI requiring PD between 2003 and 2005, and controls matched by type of surgery and body
weight. Acid-base variables, including blood gas data and electrolytes, were assessed. The Stewart-Figge variables, including
strong ion difference apparent (SIDa), strong ion difference effective (SIDe), and strong ion gap (SIG), were calculated.
Results Blood gas analyses showed that the PD group was more acidemic, with a lower mean bicarbonate and a lower mean base excess,
typical features of metabolic acidosis. The strong ion analyses revealed that the PD group had lower mean sodium and albumin
concentrations. Based on the Stewart-Figge methodology, SIDa was smaller in the PD group than in the control group, but SIG
was similar in the two groups. Receiver-operating characteristic curve analyses showed that serum albumin was the only prognostic
factor associated with PCCU mortality, even after adjustment for PD treatment.
Conclusion Patients with AKI requiring PD in a pediatric cardiac care unit had significant metabolic acidosis compared to controls matched
by the type of surgery and body weight. Hyponatremia and hypoalbuminemia were characteristics of these patients. The calculated
SIDa was smaller in the PD than in the control group. Only the serum albumin had a significant prognostic value. 相似文献
14.
目的 探讨RIFLE标准在心脏术后急性肾损伤(AKI)病人肾替代治疗时机选择中的作用及与预后的关系.方法 回顾分析145例心脏术后AKI病例,分为连续性静脉一静脉血液滤过(CVVH)组(98例)和非CVVH组(47例).应用RIFLE标准对AKI进行分期,对比分析各组病人的临床资料、疗效和预后.结果 AKI Ⅰ期和Ⅲ期中CVVH组与非CVVH组的医院病死率差异无统计学意义;Ⅱ期中非CVVH组的医院病死率高于CVVH组(58.8%对26.1%,P<0.0).CVVH组生存者中,CVVH治疗、尿量恢复、机械通气、ICU滞留和术后医院滞留时间随AKI分期的加重而延长.结论 RIFLE标准对心脏术后AKI早期诊断和判断预后有指导意义.必须强调肾脏替代时机的选择,在AKI Ⅱ期即行肾替代治疗可以明显改善预后,而CVVH比间断血液透析和腹膜透析更有优势. 相似文献
15.
Outcome in pediatric acute kidney injury (AKI) is in part related to diagnosis and intervention. Standard markers of severity of illness do not identify AKI. Modified RIFLE criteria are shown to identify patients who develop AKI, potentially allowing for early intervention. 相似文献
16.
17.
18.
Vesna Stojanović Nenad Barišić Borko Milanović Aleksandra Doronjski 《Pediatric nephrology (Berlin, Germany)》2014,29(11):2213-2220
Background
The factors that contribute to the development of acute kidney injury (AKI) and treatment outcome among prematurely born neonates are not clearly understood.Methods
This retrospective study included 150 prematurely born neonates. AKI was defined as an increase of serum creatinine levels ≥0.3 mg/dl compared to basal values.Results
The majority of neonates with AKI (94.8 %) had a body weight <1,500 g. Logistic regression analysis showed that the Apgar score in the 5th minute <5, serum lactate levels >5 on the first day of life, core body temperature <36?ºC on the first day of life, occurrence of sepsis, intracranial hemorrhage, necrotizing enterocolitis, patent ductus arteriosus, as well as a treatment with vancomycin or dopamine were independent risk factors for the development of AKI. After the groups of neonates with and without AKI were adjusted, the calculated risk ratio for a negative outcome of treatment (death) was 2.215 (CI 1.27–3.86) for neonates with AKI. Neonates with AKI had higher serum sodium levels in the third and fourth days of life.Conclusions
AKI is associated with high mortality in preterm neonates. It is very important to identify, as quickly as possible, all infants who are at high risk of developing AKI. 相似文献19.
20.
Urine IL-18 is an early diagnostic marker for acute kidney injury and predicts mortality in the intensive care unit 总被引:16,自引:0,他引:16
Parikh CR Abraham E Ancukiewicz M Edelstein CL 《Journal of the American Society of Nephrology : JASN》2005,16(10):3046-3052
Serum creatinine is not an ideal marker of renal function in patients with acute kidney injury (AKI). Previous studies demonstrated that urinary IL-18 is increased in human AKI. Thus, whether urine IL-18 is an early diagnostic marker of AKI was investigated. A nested case-control study was performed within the Acute Respiratory Distress Syndrome (ARDS) Network trial. AKI was defined as an increase in serum creatinine by at least 50% within the first 6 d of ARDS study enrollment. A total of 400 urine specimens that were collected on study days 0, 1, and 3 of the ARDS trial were available from 52 case patients and 86 control patients. The data were analyzed in a cross-sectional manner and according to the time before development of AKI. The median urine IL-18 levels were significantly different at 24 and 48 h before AKI in case patients as compared with control patients. On multivariable analysis, urine IL-18 values predicted development of AKI 24 and 48 h later after adjustment for demographics, sepsis, Acute Physiologic Assessment and Chronic Health Evaluation (APACHE) III score, serum creatinine, and urine output. Urine IL-18 levels of >100 pg/ml are associated with increased odds of AKI of 6.5 (95% confidence interval 2.1 to 20.4) in the next 24 h. On diagnostic performance testing, urine IL-18 demonstrates an area under the receiver operating characteristic curve of 73% to predict AKI in the next 24 h. The urine IL-18 values were also significantly different between survivors and nonsurvivors (P < 0.05), and on multivariable analysis, the urine IL-18 value on day 0 is an independent predictor of mortality. Urinary IL-18 levels can be used for the early diagnosis of AKI. Urine IL-18 levels also predict the mortality of patients who have ARDS and are in the intensive care unit. 相似文献