Clinical course and mortality risk factors in critically ill children requiring continuous renal replacement therapy.
OBJECTIVE
To study the clinical course in children requiring continuous renal replacement therapy (CRRT) and to analyse factors associated with mortality.


METHODS
Prospective observational study.


METHODS
Paediatric intensive care department of a tertiary university hospital.


METHODS
Critically ill children with CRRT were included in the study.


METHODS
Continuous renal replacement therapy.


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.
Pediatric Intensive Care Service, Hospital General Universitario Gregorio Marañón, Dr Castelo 47, Madrid, Spain.
Maria J
MJ
Santiago
Jesús
J
López-Herce
Javier
J
Urbano
Maria José
MJ
Solana
Jimena
J
del Castillo
Yolanda
Y
Ballestero
Marta
M
Botrán
Jose María
JM
Bellón
D058186:Acute Kidney Injury / Q000150:complications / Q000401:mortality / Q000628:therapy*; D000293:Adolescent; D000704:Analysis of Variance; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D016638:Critical Illness / Q000401:mortality / Q000628:therapy; D005260:Female; D006801:Humans; D007022:Hypotension / Q000209:etiology / Q000401:mortality; D007223:Infant; D008297:Male; D009102:Multiple Organ Failure / Q000209:etiology / Q000401:mortality; D011446:Prospective Studies; D012372:ROC Curve; D017582:Renal Replacement Therapy / Q000379:methods / Q000401:mortality*; D012307:Risk Factors; D012720:Severity of Illness Index; D016019:Survival Analysis; D055815:Young Adult