Inflammation-Based Prognostic Markers in Pediatric Continuous Renal Replacement Therapy

Résumé fourni par la source

Acute kidney injury is a major cause of morbidity and mortality in critically ill children, and continuous renal replacement therapy (CRRT) is often required in severe cases. Inflammation-based indices such as the neutrophil percentage-to-albumin ratio (NPAR) and the C-reactive protein (CRP)-to-albumin ratio (CAR), as well as procalcitonin (PCT), have been proposed as prognostic markers; however, evidence in pediatric CRRT remains limited. We retrospectively included children aged 29 days to 18 years who underwent CRRT in the Pediatric Intensive Care Unit at Manisa City Hospital from February 2021 to May 2025. Demographic and clinical data and laboratory values obtained within 24 hours prior to CRRT initiation were collected. NPAR was calculated as neutrophil percentage (%) / albumin (g/dL) and CAR as CRP (mg/L) / albumin (g/dL). A total of 41 patients were included; 29 (70.7%) survived and 12 (29.3%) died. Non-survivors had significantly higher Pediatric Risk of Mortality (PRISM) III scores (p=0.008), NPAR values (p=0.03), and PCT levels (p=0.01), while CAR did not differ between groups (p=0.79). In the receiver operating characteristic analysis, PCT [area under the curve (AUC): 0.737] and NPAR (AUC: 0.713) showed moderate discrimination for predicting mortality, whereas CAR showed poor discrimination (AUC: 0.474). NPAR and PCT may support early risk stratification in pediatric patients requiring CRRT; larger multicenter studies are warranted.

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