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

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 microg/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.