title: Pediatric patients with multi-organ dysfunction syndrome receiving continuous renal replacement therapy.
abstract: 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.
authors.affiliation: Department of Pediatrics, Renal Section, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas 77030, USA. stuartg@bcm.tmc.edu
authors.forename: Stuart L
authors.initials: SL
authors.lastname: Goldstein
authors.forename: Michael J G
authors.initials: MJ
authors.lastname: Somers
authors.forename: Michelle A
authors.initials: MA
authors.lastname: Baum
authors.forename: Jordan M
authors.initials: JM
authors.lastname: Symons
authors.forename: Patrick D
authors.initials: PD
authors.lastname: Brophy
authors.forename: Douglas
authors.initials: D
authors.lastname: Blowey
authors.forename: Timothy E
authors.initials: TE
authors.lastname: Bunchman
authors.forename: Cheryl
authors.initials: C
authors.lastname: Baker
authors.forename: Theresa
authors.initials: T
authors.lastname: Mottes
authors.forename: Nancy
authors.initials: N
authors.lastname: McAfee
authors.forename: Joni
authors.initials: J
authors.lastname: Barnett
authors.forename: Gloria
authors.initials: G
authors.lastname: Morrison
authors.forename: Kristine
authors.initials: K
authors.lastname: Rogers
authors.forename: James D
authors.initials: JD
authors.lastname: Fortenberry
mesh_terms: 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