Use of therapeutic plasma exchange in children with thrombocytopenia-associated multiple organ failure in the Turkish thrombocytopenia-associated multiple organ failure network.
Use of therapeutic plasma exchange in children with thrombocytopenia-associated multiple organ failure in the Turkish thrombocytopenia-associated multiple organ failure network.
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DOI：
10.1097/pcc.0000000000000227
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发表时间：
2014-10
期刊：
影响因子：
--
通讯作者：
Carcillo JA
中科院分区：
文献类型：
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作者：
Sevketoglu E;Yildizdas D;Horoz OO;Kihtir HS;Kendirli T;Bayraktar S;Carcillo JA
血小板减少相关的多器官功能衰竭可导致危重患儿的高死亡率，可能与血栓性微血管病的后果有关。血浆置换治疗可改善血栓性微血管病。这项观察性队列研究的目的是描述血浆置换治疗的使用与土耳其血小板减少症相关多器官衰竭网络的结局之间是否存在相关性。我们对三个不同PICU的血小板减少相关多器官衰竭患者进行了回顾性队列分析，比较了接受血浆置换（+）+标准治疗的患者与未接受血浆置换（-）仅接受标准治疗的患者。在42例血小板减少相关多器官衰竭的入组患者中，所有患者均具有原发性或继发性脓毒症诊断。15人接受血浆置换治疗（PE [+]组），27人接受标准药物治疗，不接受血浆置换（PE [-]组）。PE（+）组的平均年龄为17.69个月（8.24-54.22），PE（-）组为13.46个月（6.47-20.55）。入院时年龄（p = 0.232）、性别（p = 0.206）、血小板计数（p = 0.09）、器官衰竭指数评分（p = 0.111）和儿科逻辑器官功能障碍评分（p = 0.177）在组间无统计学差异。PE（-）组（70.37%）的总体28天死亡率高于PE（+）组（26.67%）（单变量p = 0.006;多变量控制儿科逻辑器官功能障碍、器官衰竭指数、儿科死亡风险评分和神经功能衰竭p = 0.048）。PE（+）组的住院时间延长（p = 0.004）。血浆置换治疗与生存率改善之间的正相关性支持了该治疗在土耳其血小板减少相关多器官衰竭儿童中的潜力。在控制疾病严重程度后观察到的积极（尽管不那么积极）相关治疗效果为在儿童土耳其脑炎相关多器官衰竭网络中进行随机对照试验提供了进一步的依据。样本量计算需要一项100例患者的试验，在招募50例血小板减少相关多器官衰竭患者后进行事前中期分析。
Thrombocytopenia-associated multiple organ failure can lead to high mortality in critically ill children, possibly related to consequences of thrombotic microangiopathy. Plasma exchange therapy may improve thrombotic microangiopathy. The purpose of this observational cohort study is to describe whether there is an association between use of plasma exchange therapy and outcome in the Turkish thrombocytopenia-associated multiple organ failure network. We performed a retrospective cohort analysis in patients with thrombocytopenia-associated multiple organ failure at three different PICUs comparing those who received plasma exchange (+) plus standard therapies with those who did not receive plasma exchange (−) and only received standard therapies. Among 42 of the enrolled patients with thrombocytopenia- associated multiple organ failure, all had a primary or secondary sepsis diagnosis. Fifteen received plasma exchange therapy (PE [+] group) and 27 received standard medical treatment without plasma exchange (PE [−] group). The mean age was 17.69 months (8.24–54.22) in the PE (+) group and 13.46 months (6.47–20.55) in the PE (−) group. Age (p = 0.232), gender (p = 0.206), thrombocyte count (p = 0.09), Organ Failure Index score (p = 0.111), and pediatric logistic organ dysfunction score (p = 0.177) at admission were not statistically different between groups. The overall 28-day mortality was higher in the PE (−) group (70.37%) compared with the PE (+) group (26.67%) (univariate p = 0.006; multivariate controlling for pediatric logistic organ dysfunction, Organ Failure Index, Pediatric Risk of Mortality scores, and neurological failure p = 0.048). Length of stay was increased in the PE (+) group (p = 0.004). The positive association found between use of plasma exchange therapy and improved survival supports the potential of this therapy in Turkish children with thrombocytopeniaassociated multiple organ failure. The positive, although less so, associated treatment effect observed after controlling for illness severity provides further rationale for performing a randomized controlled trial in the pediatric Turkish thrombocytopenia-associated multiple organ failure network. Sample size calculations call for a 100-patient trial with a pre hoc interim analysis after enrollment of 50 patients with thrombocytopenia-associated multiple organ failure.