TOPLINE

In children and young adults with acute lung injury (ALI) who required continuous renal replacement therapy (CRRT), neither the severity of ALI nor the degree of fluid accumulation (FA) at CRRT initiation was associated with ICU mortality or major adverse kidney events at 90 days (MAKE90). Instead, longer time to CRRT initiation and higher illness severity scores were associated with worse outcomes.

METHODOLOGY

• Researchers conducted a retrospective cohort study using data from a multicenter registry of children and young adults who received CRRT for acute kidney injury or FA between 2015 and 2021.
• A total of 312 patients with ALI — defined as receipt of invasive mechanical ventilation (IMV) with impaired oxygenation (ratio of partial pressure of oxygen in arterial blood to fraction of inspiratory oxygen concentration [PaO2/FiO2] ≤300) at CRRT initiation — were included.
• Patients were stratified by ALI severity (mild: PaO2/FiO2 200-300, moderate: 100-<200, severe: ≤100) and by FA at CRRT initiation (≤10%, >10%-20%, >20%).
• Median age was 7.4 years; 57% were male; 59% had sepsis; and median PaO2/FiO2 ratio was 134.
• Primary outcomes included ICU mortality; other outcomes included IMV and ICU free days, and MAKE90 (composite of death, kidney dysfunction, or dialysis dependence at 90 days).

TAKEAWAY

• ICU mortality was 44.6% overall and increased with ALI severity (mild 34%, moderate 40%, severe 57%; P = .005); FA categories did not show any link with ICU mortality.
• Median 28-day ventilator-free days (VFD) decreased with worsening ALI severity (mild 12 days, moderate 9 days, severe 0 days; P = .002), but FA severity was not associated with VFD.
• MAKE90 occurred in 66% of patients overall and did not differ significantly by ALI severity or FA severity.
• On multivariable analysis, longer time to CRRT initiation and higher illness-severity scores were each independently linked to higher odds of ICU mortality (adjusted odds ratio [aOR], 1.04; P = .01, and aOR, 1.25; P ≤ .001, respectively), while shorter time to CRRT initiation and lower illness-severity scores were linked to lower odds of MAKE90 (aOR, 0.95; P = .015, and aOR, 0.86; P < .001, respectively).

IN PRACTICE

"Identifying risk factors and appropriate therapeutic targets and modalities targets to improve salient outcomes may require more refined phenotyping of patients with ALI," the authors of the study wrote.

SOURCE

The study was led by Zachary A. Rumlow, University of Michigan Medical School in Ann Arbor, Michigan. It was published online on August 4 in European Journal of Pediatrics.

LIMITATIONS

Only single measurements of PaO2/FiO2 ratio and fluid balance at CRRT initiation were available, failing to capture dynamic changes in lung and kidney injury. Additionally, baseline weight and fluid accumulation data were incomplete, since patient data were captured only at the site of CRRT utilization. The study lacked a control group without CRRT and did not capture variable practice patterns across centers or net ultrafiltration data during CRRT.

DISCLOSURES

No specific funding was reported. The authors reported no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.