Analysis Of The Characteristics Of Acute Kidney Injury Onset And Related Risk Factors In Single-center Children

Objective: To investigate the clinical manifestations of acute kidney injury(AKI)and its risk factors in hospitalized children,with the aim of early detection of high-risk children,avoiding related risk factors,effectively reducing the incidence of AKI,and reducing the occurrence of complications.Methods: Using the research information retrieval platform of Jiangxi Children’s Hospital,we screened the complete medical records of hospitalized children who had two or more blood creatinine tests between January 1,2011 and September 31,2022,and whose highest blood creatinine level was 1.5 times higher than the baseline value,excluding children who required maintenance dialysis,had a history of kidney disease surgery within 90 days,and had end-stage renal disease,and defined AKI using the 2012 KDIGO guidelines published by the Organization for Improving Global Kidney Disease Prognosis.AKI was defined according to the KDIGO guideline in 2012,and was divided into infant,pediatric,adolescent,and renal recovery and deterioration groups according to age and prognosis.The clinical presentation and prognostic features were retrospectively analyzed to further investigate the risk factors contributing to the progression of AKI to stage 3 and affecting the prognosis of AKI.Results: 1.Of the 1068 cases in this study,688(64.42%)were males and 380(35.58%)were females,with a male to female ratio of 1.81:1,mean age 5.43±4.55 years,255(23.87%)in the infant group,592(55.43%)in the pediatric group,and 221(20.70%)in the adolescent group.The mean number of hospital days was12.83±11.26 days,and finally 876 cases(82.02%)recovered and 192 cases(17.92%)did not recover renal function,of which 156 cases(14.61%)died;only 408 cases(38.20%)were diagnosed with AKI at the time of discharge.2.The main causes of AKI were urological diseases(29.12 %),followed by infections(27.71 %),pyrexia(7.02 %),hematologic diseases(4.96 %),exogenous poisoning(3.74 %),and cardiovascular-related diseases(2.62 %);among the various urological diseases,nephrotic syndrome(NS),acute glomerulonephritis(AGN),urinary stones,and hemolytic uremic syndrome were the main etiologies.3.Multifactorial analysis showed that AKI stage 3,prolonged APTT,history of resuscitation,history of shock,history of RRT,and extrarenal organ failure were the independent risk factors;According to logistic regression analysis,the prediction model formula is established as follows: Logit(P)=In [P/(1-P)]=-2.571+0.819 ×AKI3stage+0.010× APTT+0.786×whether there is a history of rescue+0.698×whether there is a history of shock+0.576×whether there is a history of RRT+1.351×whether there is extrarenal organ failure,and its ROC curve is drawn.By calculating the area under the curve(AUC)as 0.781>0.75,the results indicate that the prediction model has good discrimination.4.Multifactorial analysis showed low age,high urea nitrogen,history of previous trauma,history of intervention,history of RRT,and history of surgical procedures were stage 3 as an independent risk factor;According to logistic regression analysis,it is recommended to predict the model formula as follows: Logit(P)=In [P/(1-P)]=-0.360-0.061 × Age+2.632 × History of trauma+0.030 × Urea nitrogen+1.384 ×History of intervention+1.147 ×History of RRT+0.675 ×History of surgery.The ROC curve is plotted,and the area under the curve(AUC)is calculated to be 0.670>0.50.The results indicate that the prediction model has good discrimination.Conclusion:(1)The main causes of AKI are urological diseases,with nephrotic syndrome(NS),acute glomerulonephritis(AGN),urinary stones and hemolytic uremic syndrome being the most common.(2)AKI has a high clinical underdiagnosis rate(61.80%)and a high mortality rate(14.61%).(3)Heavy AKI staging,prolonged APTT,history of resuscitation,history of shock,history of RRT,and combined extra-renal organ failure are independent risk factors for the prognosis of AKI.(4)Younger age,high urea nitrogen,history of previous trauma,history of intervention,and history of surgical procedures are independent risk factors for progression to stage 3 AKI.