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Analysis of risk factors for death in 59 cases of critically ill neonates receiving continuous renal replacement therapy: a two-centered retrospective study

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Abstract

To investigate the risk factors for death in critically ill neonates receiving continuous renal replacement therapy (CRRT). This retrospective study analyzed the clinical data of critically ill neonates receiving CRRT at two tertiary hospitals from January 2015 to December 2021. A multi-factor logistic regression analysis was performed, and the predictive value of relevant risk factors on death was verified by receiver operating characteristic (ROC) curve. A total of 59 cases of critically ill neonates were included in this study, with a mortality of 37.3%. The most common primary disease in these cases was neonatal sepsis, followed by neonatal asphyxia, and inborn errors of metabolism (IEM). Univariate analysis showed that the risk factors related to death included primary diseases; the number of organs involved in multiple organ dysfunction syndrome (MODS), neonatal critical illness scores (NCIS), and indications of CRRT; the blood lactate, blood glucose, hemoglobin, and platelet before CRRT initiation; and the incidence of bleeding or thrombosis during CRRT. Multi-factor logistic regression analysis showed that risk factors for death in critically ill neonates receiving CRRT included the occurrence of neonatal sepsis, the number of organs involved in MODS, and the NCIS. ROC curve analysis showed that the number of organs involved in MODS and NCIS had a good predictive value for death in critically ill neonates receiving CRRT, with the areas under the curve (AUC) being 0.700 and 0.810, respectively.

Conclusion: Neonatal sepsis, the number of organs involved in MODS, and NCIS were independent risk factors for death in critically ill neonates receiving CRRT. Moreover, the number of organs involved in MODS and NCIS could effectively predict death in critically ill neonates receiving CRRT.

What is Known:

• The population to which CRRT is applicable is gradually expanding from critically ill children to critically ill neonates.

• The mortality of critically ill neonates receiving CRRT remains high.

What is New:

• The most common primary disease in critically ill neonates receiving CRRT was neonatal sepsis, followed by neonatal asphyxia and inborn errors of metabolism (IEM).

• The number of organs involved in MODS and NCIS could effectively predict death in critically ill neonates receiving CRRT.

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Availability of data and materials

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Abbreviations

AKI:

Acute kidney injury

ALT:

Alanine transaminase

AST:

Aspartate aminotransferase

AUC:

Areas under the curve

BUN:

Blood urea nitrogen

CRP:

C-reactive protein

CRRT:

Continuous renal replacement therapy

CVVH:

Continuous veno-venous hemofiltration

CVVHDF:

Continuous veno-venous hemodiafiltration

IEM:

Inborn errors of metabolism

MAP:

Mean arterial pressure

MAS:

Meconium aspiration syndrome

MODS:

Multiple organ dysfunction syndrome

NCIS:

Neonatal critical illness score

NEC:

Necrotizing enterocolitis

NICU:

Neonatal intensive care unit

ROC:

Receiver operating characteristic

SCr:

Serum creatinine

VIS:

Vasoactive inotropic score

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Acknowledgements

We would like to thank Editage (www.editage.cn) for English language editing.

Funding

This study was funded by the 2020 Shanghai “Science and Technology Innovation Action Plan,” Medical Innovation Research Special Project (20Y11907000).

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Author notes

  1. Jinglin Xu and Xiaoyun Chu are co-first authors.

Authors and Affiliations

  1. Department of Neonatology, Quanzhou Maternity and Children’s Hospital, Quanzhou, 362000, China

    Jinglin Xu, Weifeng Zhang & Dongmei Chen

  2. Department of Neonatology, Shanghai Children’s Hospital, Affiliated Children’s Hospital of Shanghai Jiaotong University School of Medicine, Shanghai, 200062, China

    Xiaoyun Chu, Yifen Sun, Gang Qiu & Cheng Cai

Authors
  1. Jinglin Xu
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  2. Xiaoyun Chu
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  5. Gang Qiu
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  6. Cheng Cai
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  7. Dongmei Chen
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Jinglin Xu, Xiaoyun Chu, Cheng Cai, and Dongmei Chen. The first draft of the manuscript was written by Jinglin Xu, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding authors

Correspondence to Cheng Cai or Dongmei Chen.

Ethics declarations

Ethics approval and consent to participate

The study was approved by the Medical Ethics Committee of Quanzhou Maternity and Children’s Hospital and Shanghai Children's Hospital (2020R064-E02), and informed consent was obtained from the patients’ families.

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Not applicable.

Competing interests

The authors declare no competing interests.

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Communicated by Daniele De Luca

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Xu, J., Chu, X., Zhang, W. et al. Analysis of risk factors for death in 59 cases of critically ill neonates receiving continuous renal replacement therapy: a two-centered retrospective study. Eur J Pediatr 182, 353–361 (2023). https://doi.org/10.1007/s00431-022-04693-4

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  • DOI: https://doi.org/10.1007/s00431-022-04693-4

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