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Korean J Crit Care Med > Volume 26(3); 2011 > Article
Korean Journal of Critical Care Medicine 2011;26(3): 171-176. doi: https://doi.org/10.4266/kjccm.2011.26.3.171
소아중환자실에서 지속적 신대체 요법을 시행받은 환아에서 합병증 및 사망률 예측 인자
서울대학교 의과대학 소아과학교실
Predictors of Mortality and Complication in Pediatric Patients Who Require Continuous Renal Replacement Therapy in Pediatric Intensive Care Unit
Jae Wook Choi, Woo Jin Chung, Young Joo Han, Ju Kyung Lee, Dong In Suh, June Dong Park, Young Yull Koh
Department of Pediatric Medicine, Seoul National University College of Medicine, Seoul, Korea. jdparkmd@snu.ac.kr
BACKGROUND: The objective of this study is to analyze the factors associated with mortality and complication in children requiring continuous renal replacement therapy (CRRT) in a pediatric intensive care unit. METHODS: We retrospectively analyzed 96 patients who required CRRT at a pediatric intensive care unit in Seoul National University Hospital between April 2005 and April 2011. We evaluated the clinical features, diagnosis, mortality risk factors and complications related to CRRT. RESULTS: Univariate and multivariate analyses were performed to analyze the mortality risk factors of patients requiring CRRT. The overall mortality was 56.3%, the median age was 8 years, and the ages ranged from 4 days to 22 years. The median weight of the patients was 7.9 kg, and the weights ranged from 3.6-72.9 kg. 16 patients were diagnosed with primary renal disease, and the remainder with other underlying diseases. Mortality was higher in children who received stem cell transplantation and in children with a diagnosis of imunologic disease and neurologic disease. The Pediatric Risk of Mortality (PRISM) III score at initiating CRRT was 17.8 +/- 8.9 and the degree of fluid overload at CRRT (FO%) was 12.9 +/- 16.0. The PRISM III score at the start of CRRT and low uric acid level were the factors associated with an increased risk of mortality. Of the 96 children, 13 (13.53%) presented problems of venous catheterization. Hypotension during connection to CRRT was detected in 28 patients (29.2%). Clinically significant hemorrhage occurred in 10 patients (10.4%). CONCLUSIONS: Children who require CRRT have a high mortality rate. The higher score of PRISM III at the starting time of CRRT and the lower uric acid level are the factors associated with a higher mortality. The most frequent complication of CRRT was hypotension on connection to CRRT.
Key Words: acute renal failure; continuous renal replacement therapy; fluid overload; PRISM III; uric acid
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