Predictive value of renal color Doppler ultrasound parameters in children with acute renal injury in Pediatric Intensive Care Unit

doi:10.3877/cma.j.issn.1673-5250.2023.02.014

Objective

To explore the predictive value of renal color Doppler ultrasound parameters in children with acute renal injury (AKI) in Pediatric Intensive Care Unit (PICU).

Methods

Seventy-four children admitted to the PICU of West China Second University Hospital from January to December, 2022 were selected in this study. According to combined AKI or not, they were divided into observation group (n=34, children admitted to PICU with combined AKI) and control group (n=40, children admitted to PICU without combined AKI). Renal color Doppler ultrasound was performed in both groups. The clinical data and renal color Doppler ultrasound parameters of two groups were statistically analyzed by retrospective analysis. The general clinical data, renal parenchymal echo intensity, color Doppler flow (CDFI) score, renal artery resistance index (RRI), pulsation index (PI) and other renal color Doppler ultrasound parameters of two groups were compared, and the influencing factors of AKI in PICU children were analyzed by multivariate unconditional logistic regression analysis. The predictive value of renal color Doppler ultrasound parameters in predicting AKI in PICU children was analyzed by using receiver operator characteristic (ROC) curve. The study was conducted in accordance with World Medical Association Declaration of Helsinki revised in 2013. Informed consent was obtained from each participate.

Results

① There were no significant differences between two groups in general clinical data such as gender constituent ratio, age, body mass index (BMI) (P>0.05). ②Compared with the control group, the echo enhancement rate, renal artery RRI and renal artery PI of both renal parenchyma in the observation group were significantly higher (P<0.05), and the CDFI score was significantly lower (P>0.05). The echo intensity of bilateral renal parenchyma, renal artery RRI, and renal artery PI in observation group were significantly higher than those in control group [67.6%(23/34) vs 5.0%(2/40), (0.76±0.04) vs (0.56±0.04), (1.56±0.05) vs (1.27±0.05)], and the differences were statistically significant (χ²=32.24, t=20.51, t=23.04; P<0.001). ③The CDFI score of children in observation group was significantly lower than that in control group [0 (0, 1) vs 2 (0, 3)], and the difference was statistically significant (Z=8.08, P=0.001). ④ Multivariate logistic regression analysis showed that echo intensity of bilateral renal parenchyma (OR=7.320, 95%CI: 5.478-11.845, P<0.001), CDFI score (OR=0.447, 95%CI: 0.359-0.837, P<0.001), renal artery RRI (OR=5.117, 95%CI: 3.622-10.451, P<0.001), renal artery PI (OR=4.727, 95%CI: 1.855-20.862, P<0.001) were independent influencing factors of AKI in PICU children. ⑤The ROC curve analysis results showed that the area under the curve (AUC) of echo intensity of bilateral renal parenchyma, CDFI score, renal artery RRI and renal artery PI predicting the occurrence of AKI in PICU children were 0.667 (95%CI: 0.541-0.792, P<0.001), 0.766 (95%CI: 0.643-0.860, P<0.001), 0.840(95%CI: 0.750-0.934, P<0.001), 0.783(95%CI: 0.658-0.884, P<0.001), respectively.

Conclusions

Renal color Doppler ultrasound parameters, such as echo intensity of bilateral renal parenchyma, CDFI score, renal artery RRI and renal artery PI can provide good guidance for the clinical diagnosis of AKI in PICU children.

Key words: Acute kidney injury, Intensive care units, pediatric, Ultrasonography, Doppler, color, Renal artery, Logistic models, Root cause analysis, Child

表1 2组PICU患儿一般临床资料比较

组别	例数	性别[例数(%)]		年龄(岁，±s)	BMI(kg/m²，±s)
组别	例数	男	女	年龄(岁，±s)	BMI(kg/m²，±s)
观察组	34	20(58.8)	14(41.2)	6.8±0.5	21.7±0.9
对照组	40	24(60.0)	16(40.0)	6.6±0.4	22.0±1.2
统计量		χ²＝0.10		t＝0.31	t＝0.25
P值		0.917		0.752	0.843

表1 2组PICU患儿一般临床资料比较

组别	例数	性别[例数(%)]		年龄(岁，±s)	BMI(kg/m²，±s)
组别	例数	男	女	年龄(岁，±s)	BMI(kg/m²，±s)
观察组	34	20(58.8)	14(41.2)	6.8±0.5	21.7±0.9
对照组	40	24(60.0)	16(40.0)	6.6±0.4	22.0±1.2
统计量		χ²＝0.10		t＝0.31	t＝0.25
P值		0.917		0.752	0.843

图3 观察组1例AKI患儿(7岁，女性)左肾彩色多普勒超声声像图(仅见肾门处少量血流信号，CDFI评分为1分)

表2 2组PICU患儿双肾实质回声强度比较[例数(%)]

组别	例数	增强	正常
观察组	34	23(67.6)	11(32.4)
对照组	40	2(5.0)	38(95.0)
χ²值		32.24
P值		0.001

表2 2组PICU患儿双肾实质回声强度比较[例数(%)]

组别	例数	增强	正常
观察组	34	23(67.6)	11(32.4)
对照组	40	2(5.0)	38(95.0)
χ²值		32.24
P值		0.001

图4 观察组1例AKI患儿(10岁，女性)左肾彩色多普勒超声声像图(肾动脉RRI升高，为0.78)注：AKI为急性肾损伤，RRI为阻力指数

表3 2组PICU患儿肾动脉RRI、PI比较(±s)

组别	例数	肾动脉RRI	肾动脉PI
观察组	34	0.76±0.04	1.56±0.05
对照组	40	0.56±0.04	1.27±0.05
t值		20.51	23.04
P值		0.001	0.001

表3 2组PICU患儿肾动脉RRI、PI比较(±s)

组别	例数	肾动脉RRI	肾动脉PI
观察组	34	0.76±0.04	1.56±0.05
对照组	40	0.56±0.04	1.27±0.05
t值		20.51	23.04
P值		0.001	0.001

表4 PICU患儿并发AKI影响因素的多因素非条件logistic回归分析

影响因素	B	SE	Wald值	P值	OR值	OR值95%CI
双肾实质回声增强(vs回声正常)	0.844	0.260	10.410	<0.001	7.320	5.478~11.845
CDFI评分	－11.412	2.514	5.556	<0.001	0.447	0.359~0.837
肾动脉RRI	1.631	0.678	3.340	<0.001	5.117	3.622~10.451
肾动脉PI	0.646	0.344	7.705	<0.001	4.727	1.855~20.862

表4 PICU患儿并发AKI影响因素的多因素非条件logistic回归分析

影响因素	B	SE	Wald值	P值	OR值	OR值95%CI
双肾实质回声增强(vs回声正常)	0.844	0.260	10.410	<0.001	7.320	5.478~11.845
CDFI评分	－11.412	2.514	5.556	<0.001	0.447	0.359~0.837
肾动脉RRI	1.631	0.678	3.340	<0.001	5.117	3.622~10.451
肾动脉PI	0.646	0.344	7.705	<0.001	4.727	1.855~20.862

图5 双肾实质回声强度、CDFI评分、肾动脉RRI值和肾动脉PI值预测PICU患儿并发AKI的ROC曲线注：CDFI为彩色多普勒血流显像，RRI为血流阻力指数，PI为搏动指数，PICU为儿童重症监护病房，AKI为急性肾损伤，ROC曲线为受试者工作特征曲线

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