Background Acute kidney injury (AKI) has been characterized in high-risk pediatric hospital inpatients, in whom AKI is frequent and associated with increased mortality, morbidity, and length of stay. ...The incidence of AKI among patients not requiring intensive care is unknown. Study Design Retrospective cohort study. Setting & Participants 13,914 noncritical admissions during 2011 and 2012 at our tertiary referral pediatric hospital were evaluated. Patients younger than 28 days or older than 21 years of age or with chronic kidney disease (CKD) were excluded. Admissions with 2 or more serum creatinine measurements were evaluated. Factors Demographic features, laboratory measurements, medication exposures, and length of stay. Outcome AKI defined as increased serum creatinine level in accordance with KDIGO (Kidney Disease: Improving Global Outcomes) criteria. Based on time of admission, time interval requirements were met in 97% of cases, but KDIGO time window criteria were not strictly enforced to allow implementation using clinically obtained data. Results 2 or more creatinine measurements (one baseline before or during admission and a second during admission) in 2,374 of 13,914 (17%) patients allowed for AKI evaluation. A serum creatinine difference ≥0.3 mg/dL or ≥1.5 times baseline was seen in 722 of 2,374 (30%) patients. A minimum of 5% of all noncritical inpatients without CKD in pediatric wards have an episode of AKI during routine hospital admission. Limitations Urine output, glomerular filtration rate, and time interval criteria for AKI were not applied secondary to study design and available data. The evaluated cohort was restricted to patients with 2 or more clinically obtained serum creatinine measurements, and baseline creatinine level may have been measured after the AKI episode. Conclusions AKI occurs in at least 5% of all noncritically ill hospitalized children, adolescents, and young adults without known CKD. Physicians should increase their awareness of AKI and improve surveillance strategies with serum creatinine measurements in this population so that exacerbating factors such as nephrotoxic medication exposures may be modified as indicated.
Abstract Background The relation between blood glucose concentrations on hospital admission and in-hospital mortality in patients with acute myocardial infarction, with and without diabetes, has not ...been well characterised in Chinese patients. Methods Using the China PEACE-Retrospective Acute Myocardial Infarction Study, we took a representative sample of patients with acute myocardial infarction from 2001, 2006, and 2011 and classified them according to their blood glucose concentrations on admission to hospital (<3·9, 3·9–7·8, 7·8–11·1, ≥11·1 mmol/L). We compared in-hospital mortality across these admission glucose categories, stratified by diabetes status. The central ethics committee at the China National Center for Cardiovascular Diseases approved the study, with a waiver of patients' written consent. This study is registered with www.ClinicalTrials.gov , NCT01624883. Findings Despite an increase in the proportion of patients with diabetes admitted to hospital for acute myocardial infarction in 2001–11 (17·5% in 2001, 20·1% in 2006, and 23·1% in 2011; p=0·0001), in-hospital mortality associated with hyperglycaemia on admission did not change (p=0·2). The relation between blood glucose concentration on admission and in-hospital mortality risk in patients with acute myocardial infarction with or without recognised diabetes was consistent across different study years (p value for interaction 0·9). After adjustment for patients characteristics and clinical status, compared with euglycaemic patients (7·8–11·1 mmol/L), hyperglycaemia (≥11·1 mmol/L) was associated with an increase in mortality risk both in patients with known diabetes (odds ratio OR 2·49, 95% CI 1·59–3·90) and in patients without known diabetes (2·59, 2·17–3·09). By contrast, hypoglycaemia (<3·9 mmol/L) was associated with a greater risk of in-hospital mortality only in patients with known diabetes (2·93, 1·16–7·39). A U-shaped relation exists between blood glucose concentrations on admission and in-hospital mortality in patients with diabetes, but a more linear relationship exists in patients without diabetes. Interpretation In Chinese patients with acute myocardial infarction, both hyperglycaemia and hypoglycaemia on admission to hospital are associated with an increased risk for in-hospital mortality in patients with diabetes. However, only hyperglycaemia, but not hypoglycaemia, is a predictor of increased mortality for patients without diabetes. Funding This project was partly supported by the Research Special Fund for Public Welfare Industry of Health (201202025) from the National Health and Family Planning Commission of China, the National Key Technology R&D Program (2013BAI09B01) from the Ministry of Science and Technology of China, and grant 20131100501 from State Administration of Foreign Experts Affairs of China. HMK is supported by grant U01 HL105270-05 (Center for Cardiovascular Outcomes Research at Yale University) from the US National Heart, Lung, and Blood Institute. The sponsors had no role in the conduct of the study; the collection, management, analysis, and interpretation of the data; or the preparation or approval of the abstract.
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