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.