Advances in Clinical and Experimental Medicine

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Advances in Clinical and Experimental Medicine

2019, vol. 28, nr 5, May, p. 615–623

doi: 10.17219/acem/81051

Publication type: original article

Language: English

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Creative Commons BY-NC-ND 3.0 Open Access

Factors affecting mortality in children requiring continuous renal replacement therapy in pediatric intensive care unit

Monika Miklaszewska1,A,B,C,D, Przemysław Korohoda2,C,D, Katarzyna Zachwieja1,B,E, Alina Sobczak3,B, Krzysztof Kobylarz4,B, Constantinos J. Stefanidis5,E,F, Jolanta Goździk6,B, Dorota Drożdż1,E,F

1 Department of Pediatric Nephrology and Hypertension, Jagiellonian University Medical College, Kraków, Poland

2 Department of Electronics, Faculty of Computer Science, Electronics and Telecommunications, AGH University of Science and Technology, Kraków, Poland

3 Department of Pediatrics, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland

4 Department of Anesthesiology and Intensive Care, Institute of Pediatrics, Jagiellonian University Medical College, Kraków, Poland

5 Department of Pediatric Nephrology, A. and P. Kyriakou Children’s Hospital, Athens, Greece

6 Department of Transplantology, Division of Clinical Immunology and Transplantation, Jagiellonian University Medical College, Kraków, Poland

Abstract

Background. Acute kidney injury (AKI) occurs in up to 30% of pediatric intensive care unit (PICU) patients and is associated with a high mortality rate.
Objectives. The objective of the study was to evaluate factors associated with the outcome and to identify the prognostic factors in children receiving continuous renal replacement therapy (CRRT).
Material and Methods. This was a retrospective, single-center study, including 46 patients.
Results. Logistic regression analysis demonstrated significant effects on patient survival exerted by the percentage of fluid overload (FO%) (odds ratio (OR): 1.030; p = 0.044). In the group of patients with FO% < 25%, the mortality was 33.3%, and in the FO% ≥ 25% group, the mortality was 67.9% (p < 0.001). The probability of death without multi-organ failure (MOF) was 13%, while with MOF it was 74%. There was no difference in the duration of hospitalization between the CRRT patients (mean: 21.9 days) and the general population of children hospitalized in PICU in the same period (n = 3,255; mean: 25.4 days); however, a significant difference was noted in mortality between the 2 groups of patients (54% vs 6.5%; p < 0.001).
Conclusion. The mortality of PICU CRRT patients is more than 8-fold higher than the mortality of the total PICU population. Coexisting MOF increases the mortality almost 6 times. The mortality of children with FO% ≥ 25% was more than 2-fold higher than the mortality of children with FO% < 25%.

Key words

acute kidney injury, survival, anticoagulation, pediatric intensive care unit, continuous renal replacement therapy

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