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Clinical Subphenotypes and Short-Term Outcomes in PICU Patients Receiving Continuous Blood Purification

Kaizong Huang1, Jiahua Ke1, Zhiyuan Wang2

  • 1Department of Pharmacy, Nanjing First Hospital, China Pharmaceutical University, Nanjing, China.

Critical Care Explorations
|August 18, 2026
PubMed

Insights

Continuous blood purification (CBP) in pediatric intensive care units (PICUs) identified three distinct patient subphenotypes at treatment initiation. These subphenotypes demonstrate varied short-term outcomes and prognoses, indicating significant clinical heterogeneity.

Area of Science:

  • Pediatric critical care medicine
  • Nephrology
  • Data science in healthcare

Background:

  • Continuous blood purification (CBP) is utilized in pediatric intensive care units (PICUs) for critically ill children.
  • Clinical heterogeneity exists among these patients, impacting treatment response and outcomes.
  • Identifying distinct patient subphenotypes is crucial for personalized medicine approaches.

Purpose of the Study:

  • To characterize clinical heterogeneity in pediatric patients receiving CBP.
  • To identify data-driven subphenotypes associated with different short-term outcomes.
  • To explore the prognostic implications of these subphenotypes.

Main Methods:

  • A multicenter, retrospective cohort study involving 598 children (1 month to 18 years) receiving CBP.
  • Unsupervised clustering analysis was performed at CBP initiation using a seven-variable signature.
  • Variables included aspartate aminotransferase, hemoglobin, oxygenation index, Pediatric Logistic Organ Dysfunction-2 score, procalcitonin, weight, and pH.

Main Results:

  • Three reproducible subphenotypes were identified, displaying distinct multidomain physiologic profiles, not just varying severity.
  • Subphenotype II showed the poorest short-term survival, while Subphenotype I had the most favorable profile, with Subphenotype III intermediate.
  • Significant differences were observed in 28-day survival, ICU length of stay, and exploratory associations between hemofiltration and discharge across subphenotypes.

Conclusions:

  • Pediatric patients receiving CBP exhibit distinct subphenotypes at treatment initiation with divergent short-term prognoses.
  • Subphenotype-based stratification can enhance risk characterization and clinical trial design.
  • Further prospective validation is warranted to confirm these findings and their clinical utility.
Abstract

Keywords:
clinical subphenotypesmachine learningpediatric intensive careprecision medicinerenal replacement therapy

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