Objective Secondary acute renal failure in pediatric patients is often combined with multi-organ dysfunction syndrome (MODS) and is associated with a high mortality rate. The aim of this study is to document illness severity and to look for prognostic factors in children with MODS receiving continuous renal replacement therapy (CRRT).
Methods From 1985 to 2005, 97 pediatric patients with MODS were treated with CRRT at the Pediatric ICU, Children’s Hospital, Medical University of Graz.
Results The mean age of the patients was 4.0±0.6 years, and the mean body weight was 15.1±1.7 kg.
The most common causes leading to CRRT were cardiocirculatory failure (56%) and sepsis (20%). Overall survival rate was 49.5%. Mean arterial pressure was significantly lower for non-survivors versus survivors (50.6±1.9 vs 59.7±1.9 mmHg) at initiation of CRRT, patients with a fluid overload higher than 20% of body weight, and patients on vasopressor support had mortality rates of 73.7 and 65%, respectively. Immunosuppressed patients had a mortality rate of 83% and all patients with additional failure of the GI tract died. The mean number of OSF and PRISM scores at initiation of CRRT were 3.5±0.16 and 13.9±1.1, respectively, in survivors and 4.2±0.17 (p<0.01) and 19.6±1.6 (p<0.01), respectively, in non-survivors. The main reason for mortality was a persisting MODS.
Conclusion Despite CRRT, persisting MODS results in a high mortality rate. A low mean arterial pressure, vasopressor support and a fluid overload >20% of body weight at initiation of CRRT are also associated with a significantly higher mortality rate.