Hui Wun Fung, Cheung Wing Lum, Hon Kam Lun, Ku Shu Wing
Department of Paediatrics and Adolescent Medicine, Hong Kong Children's Hospital, Kowloon, Hong Kong.
Int J Artif Organs. 2023 Apr;46(4):241-247. doi: 10.1177/03913988231163608. Epub 2023 Mar 24.
Extracorporeal blood purification (EBP) is increasingly applied for bilirubin removal in critical care setting. We retrospectively reviewed the clinical features of children aged 1 month to 18 years old who received EBP for hyperbilirubinemia and explored the bilirubin removal kinetics by hemoadsorption (HA) in the pediatric intensive care unit of Hong Kong Children's Hospital from 3/2019 to 7/2022. Among the 14 episodes of EBP from six patients with a median age (interquartile range [IQR]) of 9.3(5.5) years old, 57.1% of them received HA, 33.3% received single-pass albumin dialysis (SPAD), and 7.1% received combined SPAD and HA. All HA episodes employed the Cytosorb column. The median (IQR) pre-HA peak total bilirubin level was 406 (254) μmol/L. The saturation duration per HA episode was significantly shorter than the corresponding total treatment duration (8 vs 24 h, = 0.012), and the median total and effective HA doses were 9.8(6.8) L/kg and 300.0 (163.4) mL/kg/h respectively. The overall bilirubin removal ratio by HA was 44.6 (14.5)%. A higher HA effective dose and a higher pre-HA bilirubin level were both associated with better bilirubin removal. No major EBP-specific complication was encountered. The liver enzymes showed improvement in all children. No patients required liver transplantation. There was no EBP-related mortality, but the overall PICU mortality of the cohort was 50%. HA was a safe and effective modality for bilirubin removal among children. Future studies should investigate the impact of bilirubin removal on clinical outcomes and explore the factors responsible for better removal efficacy.
体外血液净化（EBP）在重症监护环境中越来越多地用于胆红素清除。我们回顾性分析了2019年3月至2022年7月在香港儿童医院儿科重症监护病房接受EBP治疗高胆红素血症的1个月至18岁儿童的临床特征，并探讨了血液吸附（HA）的胆红素清除动力学。在6例患者的14次EBP治疗中，中位年龄（四分位间距[IQR]）为9.3（5.5）岁，其中57.1%接受HA，33.3%接受单通道白蛋白透析（SPAD），7.1%接受SPAD与HA联合治疗。所有HA治疗均使用Cytosorb柱。HA治疗前总胆红素峰值的中位（IQR）水平为406（254）μmol/L。每次HA治疗的饱和持续时间明显短于相应的总治疗持续时间（8小时对24小时，P = 0.012），HA的中位总剂量和有效剂量分别为9.8（6.8）L/kg和300.0（163.4）mL/kg/h。HA的总体胆红素清除率为44.6（14.5）%。较高的HA有效剂量和较高的HA治疗前胆红素水平均与更好的胆红素清除相关。未遇到重大的EBP特异性并发症。所有儿童的肝酶均有改善。无患者需要肝移植。无EBP相关死亡，但该队列的总体儿科重症监护病房死亡率为50%。HA是儿童胆红素清除的一种安全有效的方式。未来的研究应调查胆红素清除对临床结局的影响，并探索导致更好清除效果的因素。
