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Clinical course and mortality risk factors in critically ill children requiring continuous renal replacement therapy
Maria J Santiago1, Jesús López-Herce, Javier Urbano
1Pediatric Intensive Care Service, Hospital General Universitario Gregorio Marañón, Dr Castelo 47, Madrid, Spain.
Insights
Mortality is high in children needing continuous renal replacement therapy (CRRT), especially those with hemodynamic instability or multiorgan failure. Severity scores often underestimate this risk in pediatric critical care.
Area of Science:
- Pediatric Critical Care Medicine
- Nephrology
- Intensive Care Medicine
Background:
- Continuous renal replacement therapy (CRRT) is a life-saving intervention for critically ill children.
- Understanding factors influencing outcomes in this vulnerable population is crucial for improving care.
Purpose of the Study:
- To investigate the clinical course of children undergoing CRRT.
- To identify factors associated with mortality in pediatric patients receiving CRRT.
Main Methods:
- Prospective observational study conducted in a tertiary university hospital's pediatric intensive care unit.
- Included critically ill children requiring CRRT.
- Analyzed mortality using univariate and multivariate analyses and assessed severity scores (PRISM, PIM II, PELOD).
Main Results:
- Overall mortality was 35.6% in 174 children treated with CRRT.
- Higher mortality observed in infants (<12 months) and patients with sepsis.
- Hemodynamic disturbances and multiorgan failure were significant risk factors for mortality.
Conclusions:
- Children requiring CRRT face a high mortality risk.
- Hemodynamic instability and multiorgan failure at CRRT initiation are key predictors of mortality.
- Current clinical severity scores tend to underestimate mortality in this patient group.
Objective:
To study the clinical course in children requiring continuous renal replacement therapy (CRRT) and to analyse factors associated with mortality.
Design:
Prospective observational study.
Setting:
Paediatric intensive care department of a tertiary university hospital.
Patients:
Critically ill children with CRRT were included in the study.
Intervention:
Continuous renal replacement therapy.
Measurements And Results:
Univariate and multivariate analyses were performed to analyse the influence of each factor on mortality. The ability of the PRISM, PIM II and PELOD severity of illness scores to predict mortality was tested using receiver-operating characteristic curve statistics. A total of 174 children aged between 1 month and 22 years were treated with CRRT. Mortality was 35.6%, and multiorgan failure and haemodynamic disturbances were the principal causes of death. Mortality was higher in children less than 12 months of age (44.7%; P = 0.037) and in patients with a diagnosis of sepsis (44.1%; P = 0.001). Haemodynamic disturbances at the time of starting CRRT (hypotension or need for adrenaline >0.6 microg/kg/min) and the presence of multiorgan failure were the factors associated with an increased risk of mortality. The PRISM scale was the severity score with the best predictive capacity, although all three scales underestimated the actual mortality.
Conclusions:
Mortality in children who require CRRT is high. Haemodynamic disturbances and the presence of multiorgan failure at the time of starting the technique are the factors associated with a higher mortality. The clinical severity scores underestimate mortality in children requiring CRRT.
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