脓毒性休克患儿启动连续性肾脏替代治疗的影响因素分析OA

Objective To explore the utilization rate of continuous renal replacement therapy(CRRT)and the influencing factors for initiating CRRT in children with septic shock.Methods A retrospective analysis was conducted on the clinical data of 206 pediatric patients diagnosed with septic shock and admitted to the department of pediatric intensive care unit(PICU)of Shengjing Hospital of China Medical University,between January 2015 and December 2024.The patients were divided into two cohorts according to receipt of CRRT:the CRRT group and the non-CRRT group.Baseline demographic and clinical characteristics,in-hospital management strategies,and serial laboratory parameters were systematically compared between the two groups.Multivariable Logistic regression modeling was performed to identify independent predictors associated with CRRT initiation.Receiver operator characteristic curve(ROC curve)analysis was conducted to assess the discriminatory capacity of significant predictors,and the statistical significance of differences in area under the curve(AUC)was evaluated using the Delong test.Results A total of 206 pediatric patients with septic shock were enrolled;the overall CRRT utilization rate was 23.30％(48/206).From 2019 to 2024,a statistically significant downward trend in CRRT use was observed(x2=4.222,P=0.040),corresponding to an average annual decline of 4.73％.Compared with the non-CRRT group,the CRRT group exhibited significantly higher values for age,body weight,procalcitonin(PCT),lactic acid(Lac),incidence of acute kidney injury(AKI)stage 3,fluid net balance,pediatric risk of mortality-Ⅲ(PRISM-Ⅲ)score,vasoactive-inotropic score(VIS)and multiple organ dysfunction syndrome(MODS)incidence[age(months):77.5(23.3,113.8)vs.16.0(4.0,90.0),body weight(kg):19.0(10.3,33.0)vs.11.5(7.3,29.0),PCT(μg/L):55.8(18.3,100.0)vs.30.2(6.3,87.9),Lac(mmol/L):2.8(1.5,5.0)vs.1.3(0.9,2.2),incidence of AKI stage 3:41.67％(20/48)vs.8.86％(14/158),fluid net balance(mL·kg-1·h-1):5.6(1.8,10.6)vs.2.3(0.9,5.8),PRISM-Ⅲ score:13.0(8.0,20.8)vs.8.0(3.0,13.0),VIS:10.6(5.0,30.0 vs.0.0(0.0,2.5),and MODS incidence:97.92％(47/48)vs.65.19％(103/158);all P<0.05].Conversely,mean arterial pressure MAP,6-hour lactate clearance rate(LCR),arterial pH,and base excess(BE)were significantly lower in the CRRT group[MAP(mmHg,1 mmHg≈0.133 kPa):58.0(51.2,70.0)vs.66.7(60.3,77.0),6-hour LCR(％):22.9(-52.4,46.0)vs.44.6(9.1,66.7),pH value:7.3(7.2,7.4)vs.7.4(7.4,7.5),BE:-6.9(-12.3,-1.2)vs.-2.1(-6.7,0.8);all P<0.05].A multivariate Logistic regression analysis was conducted on the above-mentioned influencing factors for a multiple regression analysis.The results showed that 6-hour LCR[odds ratio(OR)=0.295,95％confidence interval(95％CI)was 0.121-0.720]and PRISM-Ⅲ score(OR=1.191,95％CI was 1.082-1.311)were independent influencing factors for children with septic shock who received CRRT(all P<0.05).ROC curve analysis demonstrated that the combination of 6-hour LCR and PRISM-Ⅲ score yielded optimal discriminatory performance for predicting CRRT use,with area under the curve(AUC)of 0.749,sensitivity of 58.3％,and specificity of 83.9％,P<0.05.Conclusions The utilization of CRRT among pediatric patients with septic shock has declined significantly in recent years.The 6-hour LCR and PRISM-Ⅲ score are independent predictors of mortality in children with septic shock undergoing CRRT.The predictive model constructed from these two combined indicators demonstrates good efficacy in forecasting CRRT necessity.