Timing Of Continuous Renal Replacement Therapy In Children With Severe Sepsis

Sepsis is a systemic inflammatory response syndrome caused by infection.The pathogenesis of sepsis is complex,if the body can not control and adapt to the damage of endotoxin and cytokines,the cytokine storm will cause imbalance of immune homeostasis and lead to capillary leakage and multiple organ dysfunction,which will lead to early death of patients.Continuous renal replacement therapy(CRRT)can not only clear inflammatory mediators and endogenous toxins,but also continuously clear fluid,maintain water balance and hemodynamic stability,and improve multiple organ failure,which play an important role in the treatment of sepsis.At present,timing of CRRT in children with severe sepsis remains to be confirmed.This study retrospectively analyzed the differences of various indicators in different CRRT time in children with severe sepsis,hoping to provide a theoretical basis and practical significance for clinical treatment.Objective:We summarized and collected the clinical data of children with severe sepsis and treated by CRRT in the pediatric intensive care unit(PICU)of the First Hospital of Jilin University from January 2015 to November 2020,and to evaluate the impact of initiation of CRRT on children with severe sepsis.Method:Children with severe sepsis and treated by CRRT from January 2015 to November 2020 were Summarized and collected.According to whether they received CRRT within 24 hours after admission to PICU,they were divided into two groups,the patients in the early group were treated with CRRT within 24 hours,and those in the late group were treated with CRRT after 24 hours.They were analyzed on gender,age,weight,whether they used vasoactive drugs,prism-Ⅲ score,time to start CRRT after admission to PICU,duration of mechanical ventilation,duration of CRRT,length of PICU stay,P/F,creatinine,urea nitrogen,hemodynamic indexes and inflammatory indexes of the two groups before and after CRRT treatment,complication,the outcome of the two groups,such as survival/mortality.Logistic regression analysis was used to screen the risk factors of death in children who had severe sepsis and treated with CRRT.Results:1.Respiratory tract infection was the main infection site in all the enrolled patients(55%).Among them,42 cases(62.69%)were complicated with respiratory failure,3 cases(4.48%)with acute respiratory distress syndrome,15 cases(22.39%)with acute kidney injury,and 11 cases(16.42%)with multiple organ dysfunction.There was no significant difference in age,gender,weight,mechanical ventilation and vasoactive drugs between the two groups(P > 0.05).In terms of disease severity,there was no significant difference in prism-Ⅲ score between the two groups(P > 0.05).2.(1)Comparison of clinical indexes before and after CRRT treatment: there was no significant difference in mean arterial pressure,heart rate,P/F between the two groups before treatment(P > 0.05).After CRRT treatment,the mean arterial pressure of the two groups increased,the heart rate of the two groups decreased,the P/F increased,and the degree of the early group was greater,but the difference was not statistically significant(P > 0.05).(2)Comparison of infection indexes before and after CRRT treatment: there was no significant difference in WBC,CRP,PCT between the two groups before treatment(P>0.05).After CRRT treatment,CRP in the early group decreased after 3 days of treatment,and CRP in the late group decreased after 7 days of treatment,the difference was statistically significant(P < 0.05).(3)Comparison of renal function of AKI children before and after CRRT: there was no significant difference in urine volume,serum creatinine and urea nitrogen between the two groups before treatment(P > 0.05).The serum creatinine of the two groups decreased after treatment,and the decrease degree of the early group was greater,and the difference was statistically significant(P < 0.05);the urea nitrogen of the two groups decreased after treatment,and the decrease degree of the early group was greater,but there was no significant difference(P > 0.05).3.The mortality in the early group was lower than that in the late group(27.8%vs 68.42%),with statistical significance(P < 0.05).4.Logistic regression analysis showed that timing of CRRT,prism-Ⅲ score and P/F were independent risk factors of death in children with severe sepsis.The timing of CRRT and prism-Ⅲ score have good predictive value.Conclusion:1.Early CRRT treatment can effectively reduce the infection index of children with severe sepsis and promote the recovery of renal function in children with septic AKI.2.Early CRRT treatment can effectively reduce the mortality of children with severe sepsis.3.The prism-Ⅲ score and P/F were independent risk factors for death in children with severe sepsis.