Pediatric patients with multi-organ dysfunction syndrome receiving continuous renal replacement therapy
Pediatric patients with multi-organ dysfunction syndrome receiving continuous renal replacement therapy
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DOI：
10.1111/j.1523-1755.2005.67121.x
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发表时间：
2005-02-01
影响因子：
19.6
通讯作者：
Fortenberry, JD
中科院分区：
文献类型：
--
作者：
Goldstein, SL;Somers, MJG;Fortenberry, JD
背景。与成人患者相比，导致多器官功能障碍综合征（MODS）和相关急性肾功能衰竭（ARF）的危重疾病在儿童中较少见。因此，许多问题困扰着儿科ARF结果文献，包括相对缺乏前瞻性研究，缺乏受试者人群的模式分层，以及结果分析中患者疾病严重程度的对照不一致。我们现在报告第一项多中心研究的数据，以评估MODS患儿接受持续肾脏替代治疗（CRRT）的结果。157例注册患者中有120例（63例男性/57例女性）在治疗过程中经历了MODS。116例患者有完整的数据可供分析。导致CRRT的最常见原因是脓毒症（N= 47, 39.2%）和心源性休克（N= 24, 20%）。总生存率为51.7%。儿童死亡风险（PRISM 2）评分、中心静脉压（CVP）和CRRT开始时的液体过载百分比（%FO）在幸存者中显著低于非幸存者。在CRRT开始时使用PRISM 2控制病情严重程度的多变量分析显示，即使同时接受机械通气和血管活性加压药物治疗的患者，幸存者的%FO仍显著低于非幸存者（P < 0.05）。我们推测，从PICU入院到CRRT开始的输液增加是接受CRRT的MODS患儿死亡率的独立危险因素。我们建议，在最初的复苏努力之后，应该更加强调早期开始CRRT和使用肌力药物，而不是液体给药，以维持可接受的血压。
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.Conclusion. 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.