Prediction of septic shock outcome in children requiring extracorporeal hemocorrection

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BACKGROUND

Treatment of septic shock in children is a key issue in pediatric intensive care.

OBJECTIVE

To identify significant clinical and laboratory predictors of septic shock outcomes in children requiring extracorporeal hemocorrection (EH).

MATERIAL AND METHODS

A multiple-center observational uncontrolled study included 62 children. Mean age was 5 (2—13) years. Patients were divided into 3 groups depending on timing and technique of EH. In the 1st group, EH was started as soon as signs of acute kidney injury (AKI) were found. In the 2nd group, EH was initiated prior to AKI and in patients with AKI stage 1. In these groups, patients underwent only continuous veno-venous hemodiafiltration (CVVHDF). In the 3rd group, EH was initiated immediately after diagnosis of septic shock (CVVHDF combined with polymyxin hemosrbition). Endotoxin activity and need for inotropic and vasopressor support were evaluated to assess therapeutic efficacy.

RESULTS

PRISM score has the greatest prognostic value in the 2nd group (p<0.047), whereas pSOFA score was significant in the 1st and 2nd groups (p<0.039). Catecholamine index was of great prognostic value in the 1st and 2nd groups (p<0.045). Serum lactate was more informative in the 2nd and 3rd groups (p<0.042). pSOFA score >11, PRISM-3 score >15, catecholamine index >3.9 and serum lactate >6.9 mmol/L were significant predictors of mortality.

CONCLUSION

PSOFA score >11 is an absolute indication for extracorporeal hemocorrection early after admission to ICU.

Keywords:

sepsis

septic shock

extracorporeal hemocorrection

hemoperfusion with polymyxin

children

outcome

Authors:

Aleksandrovich Yu.S.

Children’s Scientific Clinical Center for Infectious Diseases

ORCID: 0000-0002-2131-4813

Serednyakov K.V.

Children’s Research and Clinical Center for Infectious Diseases of the FMBA of Russia;
St. Petersburg State Pediatric Medical University

Rybyanov V.V.

St. Petersburg State Pediatric Medical University

Pshenisnov K.V.

Children’s Scientific Clinical Center for Infectious Diseases

ORCID: 0000-0003-1113-5296

Received:

03.05.2022

Accepted:

11.09.2022

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