Continuous Renal Replacement Therapy in Pediatric Severe Sepsis: A Propensity Score-Matched Prospective Multicenter Cohort Study in the PICU

作者：Huijie Miao, Jingyi Shi, Chunxia Wang, Guoping Lü, Xiaodong Zhu, Ying Wang, Yun Cui, Yucai Zhang · 发表于：Critical Care Medicine · 年份：2019 · DOI：10.1097/ccm.0000000000003901 · 被引用次数：42 · 研究领域：Acute Kidney Injury Research、Sepsis Diagnosis and Treatment、Antibiotics Pharmacokinetics and Efficacy

OBJECTIVES: Continuous renal replacement therapy becomes available utilization for pediatric critically ill, but the impact of mortality rate in severe sepsis remains no consistent conclusion. The aim of the study is to assess the effect of continuous renal replacement therapy in pediatric patients with severe sepsis and the impact this therapy may have on their mortality. DESIGN: Propensity score-matched cohort study analyzing data prospectively collected by the PICUs over 2 years (2016-2018). SETTING: Four PICUs of tertiary university children's hospital in China. PATIENTS: The consecutive patients with severe sepsis admitted to study PICUs were enrolled from July 2016 to June 2018. INTERVENTIONS: The patients were divided into the continuous renal replacement therapy group and the conventional (noncontinuous renal replacement therapy) group. MEASUREMENTS AND MAIN RESULTS: A total of 324 patients with severe sepsis were enrolled. The hospital mortality rate was 35.6% (64/180) in the continuous renal replacement therapy group and 47.9% (69/144) in the noncontinuous renal replacement therapy group. After propensity score adjustment, the hospital mortality rate was 21.3% (29/136) in the continuous renal replacement therapy group and 32.4% (44/136) in the noncontinuous renal replacement therapy group. In subgroup analysis, the relative risk of dying was 0.447 (95% CI, 0.208-0.961) only in patients complicated by acute respiratory distress syndrome (p = 0.037), but not in patien...