Identification Of Risk Factors And Prediction Factors Of Acute Kidney Injury In Children With Severe Infection

Objective:To find out the independent influencing factors of acute kidney injury in children with severe infection and to explore the clinical value of biomarkers in evaluating the occurrence of kidney injury.Methods:We selected the clinical data of children with severe infection and used of vancomycin in pediatric ward of Affiliated Hospital of North Sichuan Medical College from July 2018 to September 2019,and collected data of children with severe infection who were treatmented by linezolid during the same period.Serum creatine(Scr),serum cystatin c(Scys c),urinary ?1-microglobulin(?1-MG),urinary N-acetyl-?-D-gl u-cosaminidase(U-NAG)were measured before and 24 hours and 48 hours after administration of vancomycin from the blood and urine samples.In addition,the Scr and Scys c values of children in linezolid group before and 24 hours and 48 hours after treatment were detected.According to the acute kidney injury(AKI)standard of KDIGO in 2012,the two groups were divided into AKI group and non AKI group.The differences between the groups were compared by statistical method.To find the independent influencing factors of acute kidney injury,and evaluate the application value of the above markers in children with severe infection.Result:1.In this study,renal function was divided into groups according to the changes of SCR for 48 hours after vancomycin administration.43 cases of vancomycin group were collected,including 7 cases in AKI group,and the incidence of kidney injury was 16.3%.There were 28 cases in linezolid group,but none of them had kidney injury,the incidence was 0%.The difference between the two groups was statistically significant.2.Comparison of clinical data between vancomycin group and linezolid group found that blood lactic acid(Lac)was statistically significant between the two groups.But the basic blood creatinine,white blood cells(WBC),procalcitonin(PCT),albumin(Alb),and other data were not statistically significant between the two groups.3.The single factor analysis of vancomycin group showed that the PCIs,PCT,Alb and Lac levels of the children at the time of admission were significantly different between AKI group and non AKI group.4.Binary logistic regression and ROC curve suggested that PCIs and serum albumin were independent influencing factors of kidney injury in vancomycin group,and PCIs<81 points and serum albumin<32.6g/L were critical values of acute kidney injury.Their sensitivity was 63.9%and 72.2%,specificity was 85.7%and 71.4%respectively.5.Except before administration,there was significant difference in Scys c and U-NAG in AKI group and non AKI group for 24h and 48h vancomycin administration.But there was no significant difference in urinary ?1-MG level before and 24h after treatment,the change in 48h after administration was significant between the two groups.6.ROC curve analysis showed that Scr,Scys c,urinary ?1-MG,U-NAG had no diagnostic value for kidney injury;24hScys c and U-NAG had early diagnostic value for kidney injury,among which Scys c had a high diagnostic accuracy of 78.0%,with sensitivity of 71.4%,specificity of 88.9%,Scys c?1.07mg/L was the diagnostic threshold;Scr,Scys C,urinary ?1-MG,U-NAG after 48h vancomycin administration have good diagnostic efficacy for acute kidney injury.Among them,the sensitivity and specificity of Scr and U-NAG were the same,was 85.7%and 88.9%respectively,while Scys c had a relatively low sensitivity,was 71.4%,and the specificity was 97.2%,urinary al-MG had a relatively low specificity,was 75.0%,and the sensitivity was 85.7%.Conclusion:1.Also in the severely infected group,the incidence of kidney injury is higher in the vancomycin group,suggesting that vancomycin has stronger renal toxicity.2.PCIs and serum albumin level are the independent influencing factors of acute kidney injury.PCIs<81 points and serum albumin<32.6g/L are the critical values to evaluate the occurrence of vancomycin acute kidney injury in critically ill children.3.Scys c is an ideal marker for early identification of renal injury.Scys c?1.07mg/L for 24 hours is the threshold for predicting vancomycin acute renal injury based on SCR diagnosis.4.Scr and U-NAG of 48h have similar clinical value for the diagnosis of vancomycin renal injury;While the specificity of 48h Scys c is increased,its sensitivity is lower,so it is easy to make type ? error.While the sensitivity of urine ?1-MG is relatively high,its specificity is relatively low,and the probability of making.type ? error is increased.Therefore,the above indicators should be comprehensively judged clinically.