Sürekli renal replasman tedavisi uygulanan çocuk yoğun bakım ünitesi hastalarında trombositopeninin sekonder enfeksiyon ve mortalite ile ilişkisi

Abstract

Amaç Sürekli renal replasman tedavisi (SRRT), pediatrik hastalarda yaygın olarak kullanılan bir tedavi yöntemidir. Yoğun bakım ünitesine kabul sırasında ve pediatrik yoğun bakım ünitesine kabul edilen hastalarda CRRT'nin başlatılması sırasında trombositopeninin sekonder enfeksiyona ve mortaliteye duyarlılığını değerlendirmeyi amaçladık. Yöntem Şubat 2021 ile Temmuz 2024 arasında SRRT uygulanan üçüncü basamak Pediatrik Yoğun Bakım Ünitesindeki hastalarla ilgili retrospektif bir çalışma yürüttük. Çalışmaya SRRT uygulanan 34 hasta dahil edildi. Bulgular Çalışma popülasyonu, medyan yaşı 26 ay olan hastalardan oluşuyordu ve %58,8'i erkekti. PICU'ya kabulde 10 (%29,4) hastada trombositopeni vardı, buna karşın 15 (%44,1) hastada CRRT başlangıcında trombositopeni vardı. CRRT başlangıcında trombositopenisi olan hastalarda mortalite riski daha yüksekti. PICU'ya kabul edilen trombositopenili hastalarda mortalite önemli düzeye yaklaştı. Tek değişkenli ve çok değişkenli regresyon analizlerine göre SRRT başlangıcında trombositopenili hastalarda enfeksiyon riski önemli ölçüde artmıştı (p = 0,01). Sonuç SRRT başlangıcında trombositopeninin saptanması, pediatrik yoğun bakım hastanesinde yatış sırasında daha yüksek sekonder enfeksiyon oranı ve mortalite ile ilişkilidir. SRRT ve trombositopeni bağışıklık fonksiyonunu olumsuz etkiler ve bunların sonraki enfeksiyon riski ile ilişkisini değerlendirmek için daha fazla prospektif çalışmaya ihtiyaç vardır.

Keywords

• Sürekli renal replasman tedavisi
• pediatrik yoğun bakım
• trombositopeni
• sekonder enfeksiyon
• mortalite

Supporting Institution

Yok

Project Number

1668

Ethical Statement

İzmir Bakırçay Üniversitesi

Association of thrombocytopenia on secondary infection and mortality in pediatric intensive care unit patients receiving continuous renal replacement therapy

Abstract

Aims: Continuous renal replacement therapy (CRRT) is a widely used treatment modality in pediatric patients. We aimed to evaluate the susceptibility of thrombocytopenia to secondary infection and mortality during intensive care unit admission and the initiation of CRRT in patients admitted to the pediatric intensive care unit. Methods: We conducted a retrospective study of patients in a tertiary pediatric intensive care unit who underwent CRRT between February 2021 and July 2024. The study included 34 patients who underwent CRRT. Results: The study population consisted of patients with a median age of 26 months and 58.8% were male. At pediatric intensive care units (PICU) admission, 10 (29.4%) patients had thrombocytopenia, whereas 15 (44.1%) had thrombocytopenia at CRRT initiation. Patients with thrombocytopenia at the start of CRRT had a greater risk of mortality. Mortality approached significance in patients with thrombocytopenia at PICU admission. The risk of infection was significantly increased in patients with thrombocytopenia at the start of CRRT according to univariate and multivariate regression analyses (p=0.01). Conclusion: The detection of thrombocytopenia at the beginning of CRRT is associated with a higher secondary infection rate and mortality during pediatric intensive care hospitalization. CRRT and thrombocytopenia negatively impact immune function, and further prospective studies are needed to assess their association with subsequent infection risk.

Keywords

• Continuous renal replacement therapy
• pediatric intensive care
• secondary infection
• thrombocytopenia
• mortality

Supporting Institution

None

Project Number

1668

Ethical Statement

Izmir Bakircay Univercity

References

1. Westrope CA, Fleming S, Kapetanstrataki M, Parslow RC, Morris KP. Renal replacement therapy in the critically ill child. Pediatr Crit Care Med. 2018;19(3):210-217. doi:10.1097/PCC.0000000000001431
2. Ding JJ, Hsia SH, Jaing TH, et al. Prognostic factors in children with acute kidney injury requiring continuous renal replacement therapy. Blood Purif. 2024;53(6):511-519. doi:10.1159/000536018
3. Malard B, Lambert C, Kellum JA. In vitro comparison of the adsorption of inflammatory mediators by blood purification devices. Intensive Care Med Exp. 2018;6(1):12. doi:10.1186/s40635-018-0177-2
4. Kuwabara S, Goggins E, Okusa MD. The pathophysiology of sepsis-associated AKI. Clin J Am Soc Nephrol. 2022;17(7):1050-1069. doi:10. 2215/CJN.00850122
5. Semple JW, Italiano JE Jr, Freedman J. Platelets and the immune continuum. Nat Rev Immunol. 2011;11(4):264-274. doi:10.1038/nri2956
6. Griffin BR, Jovanovich A, You Z, Palevsky P, Faubel S, Jalal D. Effects of baseline thrombocytopenia and platelet decrease following renal replacement therapy initiation in patients with severe acute kidney injury. Crit Care Med. 2019;47(4):e325-e331. doi:10.1097/CCM.00000000 00003598
7. Zhang R, Huang H, Lu S, et al. Relationship between thrombocytopenia and prognosis in children with septic shock: a retrospective cohort study. Platelets. 2024;35(1):2363242. doi:10.1080/09537104.2024.2363242
8. Guru PK, Singh TD, Akhoundi A, Kashani KB. Association of thrombocytopenia and mortality in critically ill patients on continuous renal replacement therapy. Nephron. 2016;133(3):175-182. doi:10.1159/ 000447543

9. Ninmer EK, Charlton JR, Spaeder MC. Risk factors for sepsis-associated acute kidney injury in the PICU: a retrospective cohort study. Pediatr Crit Care Med. 2022;23(7):e366-e370. doi:10.1097/PCC.0000000000002957
10. Köker A, Yaman A, Akkuzu E, et al. Continuous renal replacement therapy (CRRT) protocol in critically Ill children. J Pediatr Emerg Intensive Care Med. 2024;11(1):29-56. doi:10.4274/cayd.galenos.2023. 71677
11. Fay L, Rechner-Neven G, Hammond DA, DeMott JM, Sullivan MJ. Evaluating the risk of developing thrombocytopenia within five days of continuous renal replacement therapy initiation in septic patients. J Pharm Pract. 2022;35(1):94-100. doi:10.1177/0897190020959175
12. Castillo A, Santiago MJ, López-Herce J, et al. Nutritional status and clinical outcome of children on continuous renal replacement therapy: a prospective observational study. BMC Nephrol. 2012;13:125. doi:10. 1186/1471-2369-13-125
13. Bajwa A, Kinsey GR, Okusa MD. Immune mechanisms and novel pharmacological therapies of acute kidney injury. Curr Drug Targets. 2009;10(12):1196-1204. doi:10.2174/138945009789753174
14. Chang YM, Chou YT, Kan WC, Shiao CC. Sepsis and acute kidney injury: a review focusing on the bidirectional interplay. Int J Mol Sci. 2022;23(16):9159. Published 2022 Aug 15. doi:10.3390/ijms23169159
15. Mehta RL, Bouchard J, Soroko SB, et al. Sepsis as a cause and consequence of acute kidney injury: program to improve care in acute renal disease. Intensive Care Med. 2011;37(2):241-248. doi:10.1007/s00134-010-2089-9
16. Santiago MJ, López-Herce J, Vierge E, et al. Infection in critically ill pediatric patients on continuous renal replacement therapy. Int J Artif Organs. 2017;40(5):224-229. doi:10.5301/ijao.5000587
17. Kassif Lerner R, Levinkopf D, Zaslavsky Paltiel I, et al. Thrombocytopenia and bloodstream infection: incidence and implication on length of stay in the pediatric intensive care unit. J Pediatr Intensive Care. 2021;11(3): 209-214. doi:10.1055/s-0040-1722338
18. Li X, Wang S, Ma J, Bai SG, Fu SZ. Predictive value of thrombocytopenia for bloodstream infection in patients with sepsis and septic shock. World J Crit Care Med. 2024;13(1):88540. doi:10.5492/wjccm.v13.i1.88540
19. Heybati K, Seeger R, Thyagu S, Piticaru J, Ahluwalia N, Munshi L. Catheter management across patients with hematologic malignancies and catheter-related blood stream infections: a systematic review. Ann Hematol. 2022;101(11):2515-2524. doi:10.1007/s00277-022-04969-7
20. Zhang R, Huang H, Lu S, et al. Relationship between thrombocytopenia and prognosis in children with septic shock: a retrospective cohort study. Platelets. 2024;35(1):2363242. doi:10.1080/09537104.2024.2363242
21. Griffin BR, Wu C, O’Horo JC, Faubel S, Jalal D, Kashani K. The association of platelet decrease following continuous renal replacement therapy initiation and increased rates of secondary infections. Crit Care Med. 2021;49(2):e130-e139. doi:10.1097/CCM.0000000000004763