Risk factors for early acute kidney injury after cardiac arrest in children in the pediatric intensive care unit and a prognostic analysis

ZHANG Xin-Ping, HE Jie, HUANG Jiao-Tian, CAO Jian-She, ZHU De-Sheng, XIAO Zheng-Hui

Chinese Journal of Contemporary Pediatrics ›› 2022, Vol. 24 ›› Issue (11) : 1259-1265.

PDF(582 KB)
PDF(582 KB)
Chinese Journal of Contemporary Pediatrics ›› 2022, Vol. 24 ›› Issue (11) : 1259-1265. DOI: 10.7499/j.issn.1008-8830.2205088
CLINICAL RESEARCH

Risk factors for early acute kidney injury after cardiac arrest in children in the pediatric intensive care unit and a prognostic analysis

  • ZHANG Xin-Ping, HE Jie, HUANG Jiao-Tian, CAO Jian-She, ZHU De-Sheng, XIAO Zheng-Hui
Author information +
History +

Abstract

Objective To investigate the risk factors for acute kidney injury (AKI) in children with cardiac arrest (CA) and the influencing factors for prognosis. Methods A retrospective analysis was performed on the medical records of the children who developed CA in the pediatric intensive care unit (PICU) of Hunan Children's Hospital from June 2016 to June 2021. According to the presence or absence of AKI within 48 hours after return of spontaneous circulation (ROSC) for CA, the children were divided into two groups: AKI (n=50) and non-AKI (n=113). According to their prognosis on day 7 after ROSC, the AKI group was further divided into a survival group (n=21) and a death group (n=29). The multivariate logistic regression analysis was used to investigate the risk factors for early AKI in the children with CA and the influencing factors for prognosis. Results The incidence rate of AKI after CA was 30.7% (50/163). The AKI group had a 7-day mortality rate of 58.0% (29/50) and a 28-day mortality rate of 78.0% (39/50), and the non-AKI group had a 7-day mortality rate of 31.9% (36/113) and a 28-day mortality rate of 58.4% (66/113). The multivariate logistic regression analysis showed that long duration of cardiopulmonary resuscitation (OR=1.164, 95%CI: 1.088-1.246, P<0.001), low baseline albumin (OR=0.879, 95%CI: 0.806-0.958, P=0.003), and adrenaline administration before CA (OR=2.791, 95%CI: 1.119-6.961, P=0.028) were closely associated with the development of AKI after CA, and that low baseline pediatric critical illness score (OR=0.761, 95%CI: 0.612-0.945, P=0.014), adrenaline administration before CA (OR=7.018, 95%CI: 1.196-41.188, P=0.031), and mechanical ventilation before CA (OR=7.875, 95%CI: 1.358-45.672, P=0.021) were closely associated with the death of the children with AKI after CA. Conclusions Albumin should be closely monitored for children with ROSC after CA, especially for those with long duration of cardiopulmonary resuscitation, low baseline pediatric critical illness score, adrenaline administration before CA, and mechanical ventilation before CA, and such children should be identified and intervened as early as possible to reduce the incidence of AKI and the mortality rate.

Key words

Cardiac arrest / Acute kidney injury / Pediatric intensive care unit / Child

Cite this article

Download Citations
ZHANG Xin-Ping, HE Jie, HUANG Jiao-Tian, CAO Jian-She, ZHU De-Sheng, XIAO Zheng-Hui. Risk factors for early acute kidney injury after cardiac arrest in children in the pediatric intensive care unit and a prognostic analysis[J]. Chinese Journal of Contemporary Pediatrics. 2022, 24(11): 1259-1265 https://doi.org/10.7499/j.issn.1008-8830.2205088

References

1 Dutta A, Hari KJ, Azizian J, et al. Incidence, predictors, and prognosis of acute kidney injury among cardiac arrest survivors[J]. J Intensive Care Med, 2021, 36(5): 550-556. PMID: 32242492. DOI: 10.1177/0885066620911353.
2 Para E, Azizo?lu M, Sagün A, et al. Association between acute kidney injury and mortality after successful cardiopulmonary resuscitation: a retrospective observational study[J]. Braz J Anesthesiol, 2022, 72(1): 122-127. PMID: 34823839. PMCID: PMC9373421. DOI: 10.1016/j.bjane.2021.02.026.
3 Domanovits H, Schillinger M, Müllner M, et al. Acute renal failure after successful cardiopulmonary resuscitation[J]. Intensive Care Med, 2001, 27(7): 1194-1199. PMID: 11534568. DOI: 10.1007/s001340101002.
4 Patyna S, Riekert K, Buettner S, et al. Acute kidney injury after in-hospital cardiac arrest in a predominant internal medicine and cardiology patient population: incidence, risk factors, and impact on survival[J]. Ren Fail, 2021, 43(1): 1163-1169. PMID: 34315321. PMCID: PMC8330738. DOI: 10.1080/0886022X.2021.1956538.
5 Sandroni C, Dell'anna AM, Tujjar O, et al. Acute kidney injury after cardiac arrest: a systematic review and meta-analysis of clinical studies[J]. Minerva Anestesiol, 2016, 82(9): 989-999. PMID: 26957119.
6 Mah KE, Alten JA, Cornell TT, et al. Acute kidney injury after in-hospital cardiac arrest[J]. Resuscitation, 2021, 160: 49-58. PMID: 33450335. PMCID: PMC7902429. DOI: 10.1016/j.resuscitation.2020.12.023.
7 Ca?ete P, Fernández A, Solís A, et al. Incidence and prognosis of acute kidney injury after cardiac arrest in children[J]. Nephron, 2019, 141(1): 18-23. PMID: 30343292. DOI: 10.1159/000493471.
8 Cornell TT, Selewski DT, Alten JA, et al. Acute kidney injury after out of hospital pediatric cardiac arrest[J]. Resuscitation, 2018, 131: 63-68. PMID: 30075198. PMCID: PMC6544025. DOI: 10.1016/j.resuscitation.2018.07.362.
9 Neumayr TM, Gill J, Fitzgerald JC, et al. Identifying risk for acute kidney injury in infants and children following cardiac arrest[J]. Pediatr Crit Care Med, 2017, 18(10): e446-e454. PMID: 28737594. PMCID: PMC5628129. DOI: 10.1097/PCC.0000000000001280.
10 Topjian AA, Raymond TT, Atkins D, et al. Part 4: pediatric basic and advanced life support: 2020 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care[J]. Circulation, 2020, 142(16_suppl_2): S469-S523. PMID: 33081526. DOI: 10.1161/CIR.0000000000000901.
11 Kellum JA, Lameire N, KDIGO AKI Guideline Work Group. Diagnosis, evaluation, and management of acute kidney injury: a KDIGO summary (Part 1)[J]. Crit Care, 2013, 17(1): 204. PMID: 23394211. PMCID: PMC4057151. DOI: 10.1186/cc11454.
12 Mustafa K, Buckley H, Feltbower R, et al. Epidemiology of cardiopulmonary resuscitation in critically ill children admitted to pediatric intensive care units across England: a multicenter retrospective cohort study[J]. J Am Heart Assoc, 2021, 10(9): e018177. PMID: 33899512. PMCID: PMC8200770. DOI: 10.1161/JAHA.120.018177.
13 Holmberg MJ, Ross CE, Fitzmaurice GM, et al. Annual incidence of adult and pediatric in-hospital cardiac arrest in the United States[J]. Circ Cardiovasc Qual Outcomes, 2019, 12(7): e005580. PMID: 31545574. PMCID: PMC6758564.
14 Topjian AA, de Caen A, Wainwright MS, et al. Pediatric post-cardiac arrest care: a scientific statement from the American Heart Association[J]. Circulation, 2019, 140(6): e194-e233. PMID: 31242751. DOI: 10.1161/CIR.0000000000000697.
15 Burne-Taney MJ, Kofler J, Yokota N, et al. Acute renal failure after whole body ischemia is characterized by inflammation and T cell-mediated injury[J]. Am J Physiol Renal Physiol, 2003, 285(1): F87-F94. PMID: 12657560. DOI: 10.1152/ajprenal.00026.2003.
16 Natanov R, Gueler F, Falk CS, et al. Blood cytokine expression correlates with early multi-organ damage in a mouse model of moderate hypothermia with circulatory arrest using cardiopulmonary bypass[J]. PLoS One, 2018, 13(10): e0205437. PMID: 30308065. PMCID: PMC6181365. DOI: 10.1371/journal.pone.0205437.
17 Yu L, Gu T, Zhang G, et al. The deep hypothermic circulatory arrest causes more kidney malfunctions based on a novel rabbit model[J]. Ann Saudi Med, 2014, 34(6): 532-540. PMID: 25971829. PMCID: PMC6074567. DOI: 10.5144/0256-4947.2014.532.
18 Okada A, Okada Y, Kandori K, et al. Associations between initial serum pH value and outcomes of pediatric out-of-hospital cardiac arrest[J]. Am J Emerg Med, 2021, 40: 89-95. PMID: 33360395. DOI: 10.1016/j.ajem.2020.12.032.
19 Sanchez-Pinto LN, Khemani RG. Development of a prediction model of early acute kidney injury in critically ill children using electronic health record data[J]. Pediatr Crit Care Med, 2016, 17(6): 508-515. PMID: 27124567. DOI: 10.1097/PCC.0000000000000750.
20 Hansrivijit P, Yarlagadda K, Cheungpasitporn W, et al. Hypoalbuminemia is associated with increased risk of acute kidney injury in hospitalized patients: a meta-analysis[J]. J Crit Care, 2021, 61: 96-102. PMID: 33157311. DOI: 10.1016/j.jcrc.2020.10.013.
21 Thongprayoon C, Cheungpasitporn W, Mao MA, et al. U-shape association of serum albumin level and acute kidney injury risk in hospitalized patients[J]. PLoS One, 2018, 13(6): e0199153. PMID: 29927987. PMCID: PMC6013099. DOI: 10.1371/journal.pone.0199153.
22 Nie S, Tang L, Zhang W, et al. Are there modifiable risk factors to improve AKI?[J]. Biomed Res Int, 2017, 2017: 5605634. PMID: 28744467. PMCID: PMC5514336. DOI: 10.1155/2017/5605634.
23 Kaddourah A, Basu RK, Bagshaw SM, et al. Epidemiology of acute kidney injury in critically ill children and young adults[J]. N Engl J Med, 2017, 376(1): 11-20. PMID: 27959707. PMCID: PMC5322803. DOI: 10.1056/NEJMoa1611391.
PDF(582 KB)

Accesses

Citation

Detail

Sections
Recommended

/