title: Prognosis in critically ill children requiring continuous renal replacement therapy.
abstract: We performed an observational prospective study in 53 critically ill children to analyze the prognostic factors of children requiring continuous renal replacement therapy. Pediatric index of mortality (PIM), pediatric risk of mortality score (PRISM), multi-organ failure score, serum lactate levels, blood pressure, vasoactive drugs, renal function and characteristics of renal replacement therapy were analyzed. The mortality was 32.1%, with multi-organ failure being the most frequent cause of death (59%). The children who died presented a significantly lower blood pressure and required more doses of vasoactive drugs, dopamine and epinephrine than did the survivors. The PRISM and PIM scores and the serum lactate levels and the number of organs suffering failure were significantly higher in the patients who died than in the survivors. However, the PRISM and PIM scores underestimated the risk of mortality. The age, sex, urea and creatinine levels, type of pump and volume of ultrafiltrate did not affect the prognosis. The association of a mean BP<55 mmHg and epinephrine dose >0.6 mug/kg/min was predictive of mortality in 76% of the patients. We conclude that the prognosis in children requiring renal replacement therapy depends on the severity of the clinical state at the time of starting therapy, principally on the hemodynamic situation.
authors.affiliation: Pediatric Intensive Care Unit, Gregorio Marañón Hospital, Madrid, Spain.
authors.forename: Carmen
authors.initials: C
authors.lastname: Fernández
authors.forename: Jesús
authors.initials: J
authors.lastname: López-Herce
authors.forename: Jose C
authors.initials: JC
authors.lastname: Flores
authors.forename: Dolores
authors.initials: D
authors.lastname: Galaviz
authors.forename: Marta
authors.initials: M
authors.lastname: Rupérez
authors.forename: Kay B
authors.initials: KB
authors.lastname: Brandstrup
authors.forename: Amaya
authors.initials: A
authors.lastname: Bustinza
mesh_terms: D001794:Blood Pressure; D002648:Child; D002675:Child, Preschool; D016638:Critical Illness / Q000401:mortality / Q000628:therapy*; D004305:Dose-Response Relationship, Drug; D004837:Epinephrine / Q000008:administration & dosage / Q000627:therapeutic use; D005260:Female; D017583:Hemodiafiltration; D006440:Hemofiltration; D006801:Humans; D007223:Infant; D008297:Male; D009102:Multiple Organ Failure / Q000401:mortality; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D017582:Renal Replacement Therapy; D018570:Risk Assessment
chemical_list: D004837:Epinephrine