by Miao,
Huijie; Shi, Jingyi; Wang, Chunxia; Lu, Guoping; Zhu, Xiaodong; Wang, Ying;
Cui, Yun; Zhang, Yucai
Objectives: Continuous renal replacement therapy becomes available utilization for
pediatric critically ill, but the impact of mortality rate in severe sepsis
remains no consistent conclusion. The aim of the study is to assess the effect
of continuous renal replacement therapy in pediatric patients with severe
sepsis and the impact this therapy may have on their mortality.
Design: Propensity score-matched cohort study analyzing data prospectively
collected by the PICUs over 2 years (2016–2018).
Setting: Four PICUs of tertiary university children’s hospital in China.
Patients: The consecutive patients with severe sepsis admitted to study PICUs
were enrolled from July 2016 to June 2018. Interventions: The patients were
divided into the continuous renal replacement therapy group and the
conventional (noncontinuous renal replacement therapy) group.
Measurements and Main Results: A total of 324 patients with severe sepsis
were enrolled. The hospital mortality rate was 35.6% (64/180) in the continuous
renal replacement therapy group and 47.9% (69/144) in the noncontinuous renal
replacement therapy group. After propensity score adjustment, the hospital
mortality rate was 21.3% (29/136) in the continuous renal replacement therapy group
and 32.4% (44/136) in the noncontinuous renal replacement therapy group. In
subgroup analysis, the relative risk of dying was 0.447 (95% CI, 0.208–0.961)
only in patients complicated by acute respiratory distress syndrome (p =
0.037), but not in patients with shock, acute kidney injury, acute liver
dysfunction, encephalopathy, and fluid overload greater than 10%. The mean
duration of continuous renal replacement therapy was 45 hours (26–83 hr) with
an ultrafiltration rate of 50 mL/kg/hr. The level of interleukin-6 was
decreased, and the percent of natural killer cells (%) was improved in the
continuous renal replacement therapy group compared with the noncontinuous
renal replacement therapy group. Furthermore, continuous renal replacement
therapy was an independently significant risk factor for hospital mortality in
pediatric patients with severe sepsis, and the interval between continuous
renal replacement therapy initiation and PICU admission was an independent risk
factor for hospital mortality in patients receiving continuous renal
replacement therapy.
Conclusions: Continuous renal replacement therapy with an
ultrafiltration rate of 50 mL/kg/hr decreases hospital mortality rate in
pediatric severe sepsis, especially in patients with acute respiratory distress
syndrome.
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