Risk factors of acute kidney injury secondary to multiple injuries in the children

Lin Qingbin; Wang Jian; Huang Zebin; Zhuang Jiayi

doi:10.3969/j.issn.1002-1949.2024.09.008

Abstract：Objective To investigate the risk factors of acute kidney injury(AKI)secondary to multiple injuries in the children.Methods The clinical data of 95 children with multiple injuries admitted to Dongnan Hospital of Xiamen University from January 2019 to December 2023 were retrospectively analyzed.According to the occurrence of AKI within the first week of admission,they were divided into AKI group(n=26)and non-AKI group(n=69).Gender,age,etiology,site of combined injury,length of hospital stay,injury severity score(ISS),Glasgow coma scale(GCS),operation,use of contrast agent,shock,white blood cells,hemoglobin,C-reactive protein,procalcitonin,blood lactic acid,blood glucose,blood calcium,blood creatinine,urea nitrogen,cystatin C and other indicators were compared between the two groups.The risk factors of secondary AKI in the children with multiple injuries were analyzed by univariate and Logistic multivariate analysis.The risk prediction model was established according to the multivariate analysis,and the ROC curve was drawn to evaluate the predictive value of the risk prediction model for AKI.Results The incidence of AKI was higher in the multiple injury children with head,chest and abdominal injury,use of contrast agent,GCS score≤8 score,hemoglobin＜80 g/L,high ISS score,high blood lactic acid and high cystatin C(x2=5.317,11.494,5.235,16.104,t=7.525,11.846,8.783,P＜0.05).Multivariate analysis revealed head,chest and abdominal injury(OR=3.718,95％CI 1.103-12.532),use of contrast agent(OR=4.094,95％CI 1.338-13.525),ISS score(OR=7.790,95％CI 2.644-24.238)and hemoglobin＜80 g/L(OR=6.019,95％CI 2.003-18.088)were independent risk factors for secondary AKI in the children with multiple injuries.According to the results of multivariate analysis,a risk prediction model was established[F=-53.642+1.313×(head,chest and abdominal injury=1,no head,chest and abdominal injury=0)+1.410×(use of contrast agent=1,no use of contrast agent=0)+2.053×(ISS)+0.681×(GCS ≤8 scores=1,GCS＞8 scores=0)+1.795×(hemoglobin＜80 g/L=1,hemoglobin≥80 g/L=0)+0.968 x(blood lactic acid)+1.027×(cystatin C),and ROC curve analysis showed that the model had predictive value for secondary AKI in the children with multiple injuries.The area under the curve(AUC)was 0.823,95％CI ranged from 0.717 to 0.928,P＜0.001.Conclusions Head,chest and abdominal injuries,use of contrast agent,ISS score and hemoglobin＜80 g/L are independent risk factors for secondary AKI in the children with multiple injuries.The risk prediction model established based on above-mentioned four indicators has good predictive efficacy and can be used for early screening of AKI children.