Jornal de pediatria · 2025
The role of continuous renal replacement therapy in critically ill children with cancer and multiple organ dysfunction syndrome.
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Veiga Fernanda P L F, Araujo Orlei R, Araujo Alessandra S, Bicalho Marcela S, Andrade Maria C, Silva Dafne C B
Аннотация
OBJECTIVES: To describe the demographic and clinical characteristics of pediatric cancer patients receiving continuous renal replacement therapy (CRRT) and to analyze its effect on biochemical markers.
METHODS: The authors conducted a cohort study of patients with multiple organ dysfunction syndrome (MODS) who received CRRT in a pediatric oncology intensive care unit. Biochemical measurements were compared at CRRT initiation (D0), after 72 h (D3), and during the final 72 h of therapy.
RESULTS: Fifty-nine cases were analyzed. Hospital mortality was 67.7 %, and the median duration of CRRT was 9 days. Fluid overload was present in 51 % of patients; the mean KDIGO score was 2 (SD: 1). Mechanical ventilation was required in 79.7 %. Among survivors, significant improvements were observed in pH (mean 7.34 on D0 vs. 7.41 on D3; p = 0.012; effect size: 0.72) and bicarbonate (mean 22.17 on D0 vs. 27.1 on D3; p = 0.003; effect size: 0.77). In non-survivors, lactate levels increased over time (mean 2.3 on D0 vs. 5.37 on the last day; p = 0.03; effect size: 0.49). Generalized estimating equation models identified bicarbonate (OR: 0.05), pH (OR: 0.92), PCO₂ (OR: 176), and lactate (OR: 9.8) as significant predictors of in-hospital death. Logistic regression showed that mechanical ventilation (OR: 8.48) and fluid overload in the final 72 h (OR: 1.15) were associated with mortality.
CONCLUSIONS: While CRRT's impact on mortality in MODS remains uncertain, it improved biochemical markers. The findings suggest that metabolic and lactic acidosis, fluid overload, and mechanical ventilation may be modifiable targets to reduce mortality.
METHODS: The authors conducted a cohort study of patients with multiple organ dysfunction syndrome (MODS) who received CRRT in a pediatric oncology intensive care unit. Biochemical measurements were compared at CRRT initiation (D0), after 72 h (D3), and during the final 72 h of therapy.
RESULTS: Fifty-nine cases were analyzed. Hospital mortality was 67.7 %, and the median duration of CRRT was 9 days. Fluid overload was present in 51 % of patients; the mean KDIGO score was 2 (SD: 1). Mechanical ventilation was required in 79.7 %. Among survivors, significant improvements were observed in pH (mean 7.34 on D0 vs. 7.41 on D3; p = 0.012; effect size: 0.72) and bicarbonate (mean 22.17 on D0 vs. 27.1 on D3; p = 0.003; effect size: 0.77). In non-survivors, lactate levels increased over time (mean 2.3 on D0 vs. 5.37 on the last day; p = 0.03; effect size: 0.49). Generalized estimating equation models identified bicarbonate (OR: 0.05), pH (OR: 0.92), PCO₂ (OR: 176), and lactate (OR: 9.8) as significant predictors of in-hospital death. Logistic regression showed that mechanical ventilation (OR: 8.48) and fluid overload in the final 72 h (OR: 1.15) were associated with mortality.
CONCLUSIONS: While CRRT's impact on mortality in MODS remains uncertain, it improved biochemical markers. The findings suggest that metabolic and lactic acidosis, fluid overload, and mechanical ventilation may be modifiable targets to reduce mortality.