亚临床急性肾损伤与危重新生儿预后的相关性分析

Correlation of subclinical acute kidney injury with adverse outcomes in critically ill neonates

目的探讨基于尿胱抑素C(uCys C)诊断的亚临床急性肾损伤(AKI)与危重新生儿预后的相关性。方法选择2016年7月至10月入住新生儿重症监护室(NICU)的危重新生儿为研究对象。检测新生儿入住NICU一周内uCys C水平。以最大uCys C预测死亡的ROC曲线最佳临界值界定有无肾小管损伤。将存在肾小管损伤但是无AKI,即uCys C(+)/AKI(-)定义为亚临床AKI。根据住院期间是否死亡分为死亡组和存活组;依据是否存在肾小管损伤和/或AKI,将危重新生儿分为4组。比较不同组新生儿之间临床特征差异。结果共纳入246例危重新生儿,男136例、女110例,中位年龄1.0(1.0~2.0)天;其中30例在入住NICU一周内发生AKI,24例在入住NICU期间死亡。二分类logistic回归分析发现,第1次和最大uCys C是新生儿死亡的独立危险因素(P<0.05)。根据ROC曲线结果,以最大uCys C>1558 ng/mg为存在肾小管损伤,82例(33.3%)发生了亚临床AKI。亚临床AKI组的新生儿,危重症评分高于uCys C(-)/AKI(-)组,但低于uCys C(+)/AKI(+)组;NICU住院时长长于uCys C(-)/AKI(-)组和uCys C(-)/AKI(+)组,差异均有统计学意义(P<0.05)。结论亚临床AKI与危重新生儿的不良预后有关。

Objective To investigate whether subclinical acute kidney injury(AKI)based on urinary cystatin C(uCys C)is associated with adverse outcomes in critically ill neonates.Methods Critically ill neonates admitted to the neonatal intensive care unit(NICU)from July to October 2016 were selected as the study subjects.The levels of uCys C were detected within 1 week after NICU admission.The optimal peak uCys C cutoff value of the ROC curve for predicting mortality was used to determine the presence of tubular injury.The presence of renal tubule injury without AKI(uCys C(+)/AKI(−))was defined as subclinical AKI.Neonates were divided into death group and survival group according to whether they died during hospitalization.According to the presence or absence of tubular damage and/or AKI,neonates were divided into four groups.The clinical characteristics of neonates in different groups were compared.Results A total of 246 critically ill neonates(136 boys and 110 girls)were included,with a median age of 1.0(1.0-2.0)d.Among them,30 neonates developed AKI within one week of admission to the NICU and 24 neonates died during their stay in the NICU.Binary logistic regression analysis showed that the levels of first and maximum uCys C were independent risk factors for neonatal death after adjusting for confounding factors(P<0.05).According to ROC curve results,82 neonates(33.3%)developed subclinical AKI,with the maximum uCys C level>1558 ng/mg as the presence of renal tubular injury.The score for neonatal acute physiology(SNAP)of neonates in the subclinical AKI group was higher than that in the uCys C(−)/AKI(−)group,but lower than that in the uCys C(+)/AKI(+)group.The length of NICU stay in the subclinical AKI group was longer than that in the uCys C(−)/AKI(−)and uCys C(−)/AKI(+)groups,and the differences were statistically significant.Conclusions Subclinical AKI is associated with adverse outcomes of critically ill neonates.