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Intensive Care Medicine

, Volume 36, Issue 5, pp 843–849 | Cite as

Clinical course and mortality risk factors in critically ill children requiring continuous renal replacement therapy

  • Maria J. Santiago
  • Jesús López-Herce
  • Javier Urbano
  • Maria José Solana
  • Jimena del Castillo
  • Yolanda Ballestero
  • Marta Botrán
  • Jose María Bellón
Pediatric Original

Abstract

Objective

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

Design

Prospective observational study.

Setting

Paediatric intensive care department of a tertiary university hospital.

Patients

Critically ill children with CRRT were included in the study.

Intervention

Continuous renal replacement therapy.

Measurements and 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 µg/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.

Keywords

Acute renal failure Acute kidney injury Continuous renal replacement therapy Critically ill children Outcome Hypotension Multiorgan failure PRISM 

Notes

Acknowledgments

We thank the nurses and doctors of the Paediatric Intensive Care Department of the Hospital General Universitario Gregorio Marañón for their collaboration in performing this study. This study was partially supported by the grant N. RD08/0072: Maternal, Child Health and Development Network) within the framework of the VI National I+D+i Research Program (2008–2011).

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Copyright information

© Copyright jointly held by Springer and ESICM 2010

Authors and Affiliations

  • Maria J. Santiago
    • 1
    • 3
  • Jesús López-Herce
    • 1
    • 3
  • Javier Urbano
    • 1
    • 3
  • Maria José Solana
    • 1
    • 3
  • Jimena del Castillo
    • 1
    • 3
  • Yolanda Ballestero
    • 1
    • 3
  • Marta Botrán
    • 1
    • 3
  • Jose María Bellón
    • 1
    • 2
    • 3
  1. 1.Pediatric Intensive Care ServiceHospital General Universitario Gregorio MarañónMadridSpain
  2. 2.Preventive and Quality Control ServiceHospital General Universitario Gregorio MarañónMadridSpain
  3. 3.Spanish Health Institute Carlos III, Maternal, Child Health and Development NetworkMadridSpain

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