Objectives To investigate the association of fluid overload (FO) with the development and mortality of acute kidney injury (AKI) and to evaluate the predictive value of FO in mortality of critically ill children. Method A prospective study was conducted among critically ill children who were admitted to the children's intensive care unit (PICU). FO levels were assessed during the course of the disease and PRISM Ⅲ scores were evaluated within 24 hours of admission. Binary logistic regression analyses were conducted to evaluate the association of FO with the development and mortality of AKI after adjusting for confounding factors. The area under the receiver operating characteristic curve (AUC) was calculated to assess the predictive value of FO for mortality. Results In 362 children included, there were 26 children (7.18%) having average FO≥5%, and AKI in 24 children (6.63%) and 18 children (5.0%) died. The mean FO (OR=1.26, 95%CI: 1.10~1.43, P=0.001) and the maximum FO (OR=1.12, 95%CI: 1.02~1.23, P=0.018) were significantly correlated with the development of AKI in critically ill children within 7 days of admission to PICU. However, after adjusting for age and PRISM Ⅲ, both factors had no association with AKI (all P>0.05). After adjusting for the potential confounders such as AKI and the severity of disease, the average FO was significantly associated with mortality (AOR=1.34, 95%CI: 1.12~1.60, P=0.002). The AUC of mean FO that predicted mortality risk was 0.801 (P<0.001). Conclusion Fluid overload is associated with the development and the prognosis of AKI in critically ill children, and has important predictive value for mortality.%目的 探讨容量超负荷(FO)与危重患儿急性肾损伤(AKI)、病死率的相关性,及FO对死亡的预测价值.方法 选取入住儿童重症监护病房(PICU)的危重症患儿为研究对象进行前瞻性研究.评估其病程中FO水平,并于入院24小时内进行PRISMⅢ评分.以二元logistic回归评估在校正混杂因素后FO与AKI及病死率的关系,采用受试者工作特征曲线下面积(AUC)评估FO对死亡的预测价值.结果 共纳入362例患儿,平均FO≥5%26例(7.18%),发生AKI 24例(6.63%),死亡18例(5.0%).危重患儿入住PICU 7天内,平均FO(OR=1.26,95%CI:1.10~1.43,P=0.001)和最大FO(OR=1.12,95%CI:1.02~1.23,P=0.018)均与AKI显著相关;然而在校正年龄和PRISMⅢ后,二者与AKI无相关(P>0.05).在校正AKI和疾病严重程度等潜在的混杂因素后,平均FO与病死率仍显著相关(AOR=1.34,95%CI:1.12~1.60,P=0.002).平均FO预测死亡风险的AUC为0.801(P<0.001).结论 容量超负荷与危重患儿的AKI和预后相关,并对危重患儿的死亡有重要的预测价值.
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