Correlation of acute kidney injury with in-hospital mortality after extracorporeal membrane oxygenation therapy in critically ill children
Objective To observe the incidence and classification of acute kidney injury(AKI)after 24-and 48-h extracorporeal membrane oxygenation(ECMO)therapy in critically ill children,and to explore the relationship between AKI and in-hospital mortality after ECMO therapy.Methods The clinical data of 80 critically ill children who received ECMO therapy in Henan Provincial People's Hospital from December 2017 to April 2023 were retrospectively analyzed.The occurrence and classification of AKI after 24-and 48-h ECMO therapy were counted,and the in-hospital mortality was recorded.A total of 80 critically ill children were divided into survival group and death group,and the gender ratio,age,disease type,mechanical ventilation time,ECMO mode,length of ECMO therapy,length of ICU stay,length of hospital stay,continuous renal replacement therapy status,and AKI incidence were compared between two groups.The blood sodium,potassium,creatinine,albumin,hemoglobin,white blood cell count,platelet count,and mean arterial pressure(MAP)were recorded in two groups after 24-h ECMO therapy.Multivariate Cox regression analysis was performed to assess the risk factors of in-hospital mortality in critically ill children after ECMO therapy.Results(1)AKI developed in 54 patients after 24-h ECMO therapy,including 17 cases of AKI grade 1,18 cases of AKI grade 2,and 19 cases of AKI grade 3;and developed in 51 patients after 48-h ECMO therapy,including 16 cases of AKI grade 1,9 cases of AKI grade 2,and 26 cases of AKI grade 3.Twenty-eight patients underwent continuous renal replacement therapy.(2)Among these 80 patients,ECMO was successfully weaned in 45 patients,and 38 died during hospitalization.After 24-h ECMO therapy,the platelet count was higher in survival group[(169.55±92.97)×109/L]than that in death group[(121.06±93.26)× 109/L](t=2.326,P=0.023),the blood sodium was lower in survival group[137.10(134.25,141.05)mmol/L]than that in death group[139.70(136.90,145.60)mmol/L](U=-2.115,P=0.034),the length of ICU stay and length of hospital stay were longer in survival group[20.00(16.00,28.50),31.00(24.00,43.50)d]than those in death group[8.00(5.00,12.00),8.50(5.00,12.25)d](U=6.018,P＜0.001;U=-6.627,P＜0.001),and the incidence of AKI and continuous renal replacement therapy rate were lower in survival group(52.38％,16.70％)than those in death group(84.20％,55.26％)(x2=13.800,P=0.003;x2=13.063,P＜0.001).There were no significant differences in the gender ratio,age,disease type,ECMO mode,length of ECMO therapy,mechanical ventilation time,AKI incidence after 48-h ECMO therapy,laboratory indexes after 24-h ECMO therapy(hemoglobin,albumin,blood potassium,blood creatinine,white blood cell count),and mean arterial pressure after 24-h ECMO therapy between two groups(P＞0.05).(3)Blood sodium ≥146.67 mmol/L(HR=2.965,95％CI:1.488-5.910,P=0.002)and AKI grade 3(HR=4.808,95％CI:1.792-12.901,P=0.002)were the risk factors of in-hospital mortality after 24-h ECMO therapy in critically ill children.Conclusion Blood sodium ≥146.67 mmol/L and AKI grade 3 after 24-h ECMO therapy indicate a high risk of in-hospital mortality in critically ill children.
NETL
NSTL
万方数据
维普
