Pediatric patients with multi-organ dysfunction syndrome receiving continuous renal replacement therapy.
BACKGROUND
Critical illness leading to multi-organ dysfunction syndrome (MODS) and associated acute renal failure (ARF) is less common in children compared to adult patients. As a result, many issues plague the pediatric ARF outcome literature, including a relative lack of prospective study, a lack of modality stratification in subject populations and inconsistent controls for patient illness severity in outcome analysis.


METHODS
We now report data from the first multicenter study to assess the outcome of pediatric patients with MODS receiving continuous renal replacement therapy (CRRT). One hundred twenty of 157 Registry patients (63 male/57 female) experienced MODS during their course.


RESULTS
One hundred sixteen patients had complete data available for analysis. The most common causes leading to CRRT were sepsis (N= 47; 39.2%) and cardiogenic shock (N= 24; 20%). Overall survival was 51.7%. Pediatric Risk of Mortality (PRISM 2) score, central venous pressure (CVP), and% fluid overload (%FO) at CRRT initiation were significantly lower for survivors versus nonsurvivors. Multivariate analysis controlling for severity of illness using PRISM 2 at CRRT initiation revealed that%FO was still significantly lower for survivors versus nonsurvivors (P < 0.05) even for patients receiving both mechanical ventilation and vasoactive pressors. We speculate that increased fluid administration from PICU admission to CRRT initiation is an independent risk factor for mortality in pediatric patients with MODS receiving CRRT.


CONCLUSIONS
We suggest that after initial resuscitative efforts, an increased emphasis should be placed on early initiation of CRRT and inotropic agent use over fluid administration to maintain acceptable blood pressure.
Goldstein
Stuart L
SL
Department of Pediatrics, Renal Section, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas 77030, USA. stuartg@bcm.tmc.edu
Somers
Michael J G
MJ
Baum
Michelle A
MA
Symons
Jordan M
JM
Brophy
Patrick D
PD
Blowey
Douglas
D
Bunchman
Timothy E
TE
Baker
Cheryl
C
Mottes
Theresa
T
McAfee
Nancy
N
Barnett
Joni
J
Morrison
Gloria
G
Rogers
Kristine
K
Fortenberry
James D
JD
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009102:Multiple Organ Failure / Q000401:mortality / Q000628:therapy*; D017582:Renal Replacement Therapy; D015996:Survival Rate