Multisystem Inflammatory Syndrome in Children and Acute Kidney Injury: Retrospective Study of Five Italian PICUs.

Autor:	Ricci Z; Pediatric Intensive Care Unit, Department of Anesthesia and Critical Care, Meyer Children's University Hospital, Florence, Italy.; Department of Health Sciences, Section of Anesthesiology and Intensive Care, University of Florence, Florence, Italy., Colosimo D; Pediatric Intensive Care Unit, Department of Anesthesia and Critical Care, Meyer Children's University Hospital, Florence, Italy., Cumbo S; Pediatric Intensive Care Unit, Department of Anesthesia and Critical Care, Meyer Children's University Hospital, Florence, Italy., L'Erario M; Pediatric Intensive Care Unit, Department of Anesthesia and Critical Care, Meyer Children's University Hospital, Florence, Italy., Duchini P; Pediatric Intensive Care Unit, Department of Anesthesia and Critical Care, Meyer Children's University Hospital, Florence, Italy., Rufini P; Pediatric Intensive Care Unit, Department of Anesthesia and Critical Care, Meyer Children's University Hospital, Florence, Italy., Perrotta D; Pediatric Intensive Care Unit, Department of Anesthesia and Critical Care, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy., De Sanctis F; Pediatric Intensive Care Unit, Department of Anesthesia and Critical Care, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy., Di Nardo M; Pediatric Intensive Care Unit, Department of Emergency, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy., Amigoni A; Pediatric Intensive Care Unit, Department of Woman's and Child's Health, University-Hospital, Padua, Italy., Pulitanò S; Pediatric Intensive Care Unit and Trauma Center, Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Rome, Italy.
Jazyk:	angličtina
Zdroj:	Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies [Pediatr Crit Care Med] 2022 Jul 01; Vol. 23 (7), pp. e361-e365. Date of Electronic Publication: 2022 Apr 18.
DOI:	10.1097/PCC.0000000000002955
Abstrakt:	Objectives: Multisystem inflammatory syndrome in children (MIS-C) manifests with heart dysfunction and respiratory failure some weeks after a severe acute respiratory syndrome coronavirus disease 2 infection. The aim of our study was to explore the prevalence, severity, timing, and duration of acute kidney injury (AKI) in MIS-C patients. Furthermore, we evaluated which clinical variables and outcomes are associated with AKI. Design: Multicenter retrospective study. Setting: Five tertiary hospital PICUs in Italy. Data were collected in the first 7 days of PICU admission and renal function was followed throughout the hospital stay. Patients: Patients less than 18 years old admitted to the PICU for greater than 24 hours with MIS-C. Interventions: None. Measurements and Main Results: We collected the following data, including: demographic information, inflammatory biomarkers, lactate levels, Pa o2 /F io2 , ejection fraction, N-terminal pro-B-type natriuretic peptide (NT-proBNP), renal function (serum creatinine, urinary output, fluid balance, and percentage fluid accumulation), Vasoactive-Inotropic Score (VIS), pediatric Sequential Organ Failure Assessment (pSOFA), and Pediatric Index of Mortality 3. AKI was diagnosed in eight of 38 patients (21%) and severe AKI was present in four of eight patients. In all cases, AKI was present at PICU admission and its median (interquartile range) duration was 3.5 days (1.5-5.7 d). We did not identify differences between AKI and no-AKI patients when not making correction for multiple comparisons, for example, in weight, ejection fraction, pSOFA, Pa o2 /F io2 , and lactates. We failed to identify any difference in these groups in urine output and fluid balance. Exploratory analyses of serial data between no-AKI and AKI patients showed significant differences on lymphocyte count, NT-proBNP value, ejection fraction, pSOFA, Pa o2 /F io2 , and VIS. Conclusions: In this multicenter Italian PICU experience, MIS-C is associated with AKI in one-in-five cases. In general, AKI is characterized by an associated reduction in glomerular filtration rate with a self-limiting time course. Competing Interests: The authors have disclosed that they do not have any potential conflicts of interest. (Copyright © 2022 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.)
Databáze:	MEDLINE
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