Abstract：
BACKGROUND: Acute kidney injury (AKI) is a common condition in critically ill children and is associated with increased morbidity and mortality. This study aimed to assess the performance of point-of-care ultrasonography to predict AKI in children undergoing cardiac surgery.
METHODS: In this prospective study, consecutive children underwent kidney Doppler ultrasound examination within 24 h following cardiac surgery, and an experienced operator obtained both renal resistive index (RRI) and renal pulsatility index (RPI). AKI was defined by the Kidney Disease Improving Global Outcome (KDIGO) criteria. The primary outcome was the diagnosis of severe AKI (KDIGO stage 2 or 3) on day 3.
RESULTS: A total of 58 patients were included. Median age and weight were 12.9 months (IQR 6.0-37.9) and 7.36 kg (IQR 5.19-11.40), respectively. On day 3, 13 patients were classified as having AKI, of which 11 were severe. RRI could effectively predict AKI (area under the ROC curve [AUC] 0.83, 95% CI 0.71-0.92; p < 0.001) as well as RPI (AUC 0.81, 95% CI 0.69-0.90; p < 0.001). The optimal cutoff value for RRI was 0.85 (sensitivity, 73%; specificity, 83%; positive predictive value [PPV], 50%; and negative predictive value [NPV], 93%), while for RPI was 1.95 (sensitivity, 73%; specificity, 78%; PPV, 44%; and NPV, 92%). Similar results were found in the analysis for prediction on day 5. Significant correlations were found between Doppler-based variables and estimated GFR and furosemide dose on day 3.
CONCLUSIONS: Kidney Doppler ultrasound may be a promising tool for predicting AKI in children undergoing cardiac surgery.
METHODS: In this prospective study, consecutive children underwent kidney Doppler ultrasound examination within 24 h following cardiac surgery, and an experienced operator obtained both renal resistive index (RRI) and renal pulsatility index (RPI). AKI was defined by the Kidney Disease Improving Global Outcome (KDIGO) criteria. The primary outcome was the diagnosis of severe AKI (KDIGO stage 2 or 3) on day 3.
RESULTS: A total of 58 patients were included. Median age and weight were 12.9 months (IQR 6.0-37.9) and 7.36 kg (IQR 5.19-11.40), respectively. On day 3, 13 patients were classified as having AKI, of which 11 were severe. RRI could effectively predict AKI (area under the ROC curve [AUC] 0.83, 95% CI 0.71-0.92; p < 0.001) as well as RPI (AUC 0.81, 95% CI 0.69-0.90; p < 0.001). The optimal cutoff value for RRI was 0.85 (sensitivity, 73%; specificity, 83%; positive predictive value [PPV], 50%; and negative predictive value [NPV], 93%), while for RPI was 1.95 (sensitivity, 73%; specificity, 78%; PPV, 44%; and NPV, 92%). Similar results were found in the analysis for prediction on day 5. Significant correlations were found between Doppler-based variables and estimated GFR and furosemide dose on day 3.
CONCLUSIONS: Kidney Doppler ultrasound may be a promising tool for predicting AKI in children undergoing cardiac surgery.
摘要：
背景：急性肾损伤（AKI）是危重儿童的常见病，并与发病率和死亡率增加有关。这项研究旨在评估即时超声检查的性能，以预测接受心脏手术的儿童的AKI。
方法：在这项前瞻性研究中，连续儿童在心脏手术后24小时内接受肾脏多普勒超声检查，并且经验丰富的操作者获得了肾阻力指数（RRI）和肾搏动指数（RPI）。AKI由肾脏疾病改善全球结果(KDIGO)标准定义。主要结果是在第3天诊断出严重的AKI（KDIGO2或3期）。
结果：共纳入58例患者。中位年龄和体重分别为12.9个月（IQR6.0-37.9）和7.36kg（IQR5.19-11.40），分别。在第3天，13名患者被归类为患有AKI，其中11人严重。RRI能有效预测AKI(ROC曲线下面积[AUC]0.83,95%CI0.71-0.92;p<0.001)和RPI(AUC0.81,95%CI0.69-0.90;p<0.001)。RRI的最佳截止值为0.85(灵敏度，73%；特异性，83%；阳性预测值[PPV]，50%；阴性预测值[NPV]，93%），而RPI为1.95(灵敏度，73%；特异性，78%；PPV，44%；和净现值，92%）。在第5天的预测分析中发现了类似的结果。在第3天，基于多普勒的变量与估计的GFR和呋塞米剂量之间存在显着相关性。
结论：肾脏多普勒超声可能是预测心脏手术患儿AKI的一个有前景的工具。
方法：在这项前瞻性研究中，连续儿童在心脏手术后24小时内接受肾脏多普勒超声检查，并且经验丰富的操作者获得了肾阻力指数（RRI）和肾搏动指数（RPI）。AKI由肾脏疾病改善全球结果(KDIGO)标准定义。主要结果是在第3天诊断出严重的AKI（KDIGO2或3期）。
结果：共纳入58例患者。中位年龄和体重分别为12.9个月（IQR6.0-37.9）和7.36kg（IQR5.19-11.40），分别。在第3天，13名患者被归类为患有AKI，其中11人严重。RRI能有效预测AKI(ROC曲线下面积[AUC]0.83,95%CI0.71-0.92;p<0.001)和RPI(AUC0.81,95%CI0.69-0.90;p<0.001)。RRI的最佳截止值为0.85(灵敏度，73%；特异性，83%；阳性预测值[PPV]，50%；阴性预测值[NPV]，93%），而RPI为1.95(灵敏度，73%；特异性，78%；PPV，44%；和净现值，92%）。在第5天的预测分析中发现了类似的结果。在第3天，基于多普勒的变量与估计的GFR和呋塞米剂量之间存在显着相关性。
结论：肾脏多普勒超声可能是预测心脏手术患儿AKI的一个有前景的工具。
