Alrashdi Abdulsalam S, Alshammari Jasir N, Abdullah Sulaiman K, Alqannas Sulaiman I, Faqeehi Hassan, Albatati Sawsan, Rahim Khawla A, Sandokji Ibrahim A, Alanazi Abdulkarim S, Alzabali Saeed M
Pediatric Nephrology Section, Department of Pediatric Subspecialties, Children Specialized Hospital, King Fahad Medical City, Riyadh, Saudi Arabia.
Maternity and Children's Hospital, Hail City, Saudi Arabia.
Pediatr Nephrol. 2025 May 14. doi: 10.1007/s00467-025-06794-2.
While critically ill children receiving continuous kidney replacement therapy (CKRT) are at increased risk of mortality, few studies have examined the predictors of mortality in this population. This study aimed to evaluate CKRT outcomes, focusing on predictors of mortality.
This cohort study included children aged 0-14 years who received CKRT. It collected baseline, clinical, and laboratory data. Descriptive analyses were performed. Least absolute shrinkage and selection operator (LASSO) regression was used to select the best predictors of mortality. A multivariable logistic regression model was constructed and validated with 1000 bootstraps.
This study included 113 children who received CKRT, of whom 83 (73.5%) survived and 30 (26.6%) died. Children admitted to the intensive care unit with a higher Pediatric Risk of Mortality III score, sepsis, longer intubation, or hypoalbuminemia (< 30 g/dL) were more likely to die. Multifactorial acute kidney injury was more common in those who died than in those who survived (83.3% vs. 31.3%, p < 0.01). As the exclusive indication for CKRT, fluid overload was more common in those who died than in those who survived (26.7% vs. 6.0%, p = 0.01). LASSO and multivariable regression models identified hemodynamic instability, as evidenced by inotropic support use, and abnormal coagulation, as evidenced by not using heparin anticoagulation, as independent predictors of mortality. Initiating CKRT late (> 48 h) was associated with mortality in the univariate but not the multivariate analysis.
Hemodynamic instability was the best predictor of mortality in critically ill children receiving CKRT.
接受持续肾脏替代治疗（CKRT）的危重症儿童死亡风险增加，但很少有研究探讨该人群的死亡预测因素。本研究旨在评估CKRT的治疗结果，重点关注死亡预测因素。
这项队列研究纳入了接受CKRT的0至14岁儿童。收集了基线、临床和实验室数据，并进行了描述性分析。使用最小绝对收缩和选择算子（LASSO）回归来选择最佳死亡预测因素。构建了多变量逻辑回归模型，并通过1000次自抽样进行验证。
本研究纳入了113名接受CKRT的儿童，其中83名（73.5%）存活，30名（26.6%）死亡。入住重症监护病房且儿科死亡风险Ⅲ评分较高、患有脓毒症、插管时间较长或低白蛋白血症（<30 g/dL）的儿童死亡可能性更大。多因素急性肾损伤在死亡儿童中比存活儿童更常见（83.3%对31.3%，p<0.01）。作为CKRT的唯一指征，液体超负荷在死亡儿童中比存活儿童更常见（26.7%对6.0%，p = 0.01）。LASSO和多变量回归模型确定，使用血管活性药物支持所证明的血流动力学不稳定以及未使用肝素抗凝所证明的凝血异常是死亡的独立预测因素。在单变量分析中，较晚开始CKRT（>48小时）与死亡相关，但在多变量分析中并非如此。
血流动力学不稳定是接受CKRT的危重症儿童死亡的最佳预测因素。
