Combined Therapeutic Plasma Exchange and Continuous Renal Replacement Therapy in Children With Dengue-Associated Acute Liver Failure and Shock Syndrome: Single-Center Cohort From Vietnam.

Autor:	Vo LT; Infectious Disease Department, Children Hospital 2, Ho Chi Minh City, Vietnam., Do VC; Infectious Disease Department, Children Hospital 2, Ho Chi Minh City, Vietnam., Trinh TH; Infectious Disease Department, Children Hospital 2, Ho Chi Minh City, Vietnam., Vu T; NCD Epidemiology Research Center, Shiga University of Medical Science, Otsu, Shiga, Japan.; AI Nutrition Project, National Institutes of Biomedical Innovation, Health and Nutrition, (NIBIOHN), Ibaraki, Osaka, Japan., Nguyen TT; Infectious Disease Department, Children Hospital 2, Ho Chi Minh City, Vietnam.; Woolcock Institute of Medical Research, Ho Chi Minh City, Vietnam.
Jazyk:	angličtina
Zdroj:	Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies [Pediatr Crit Care Med] 2023 Oct 01; Vol. 24 (10), pp. 818-828. Date of Electronic Publication: 2023 Jun 13.
DOI:	10.1097/PCC.0000000000003304
Abstrakt:	Objectives: Pediatric acute liver failure (PALF) is a fatal complication in patients with severe dengue. To date, clinical data on the combination of therapeutic plasma exchange (TPE) and continuous renal replacement therapy (CRRT) for managing dengue-associated PALF concomitant with shock syndrome are limited. Design: Retrospective cohort study (January 2013 to June 2022). Patients: Thirty-four children. Setting: PICU of tertiary Children's Hospital No. 2 in Vietnam. Interventions: We assessed a before-versus-after practice change at our center of using combined TPE and CRRT (2018 to 2022) versus CRRT alone (2013 to 2017) in managing children with dengue-associated acute liver failure and shock syndrome. Clinical and laboratory data were reviewed from PICU admission, before and 24 h after CRRT and TPE treatments. The main study outcomes were 28-day in-hospital mortality, hemodynamics, clinical hepatoencephalopathy, and liver function normalization. Measurements and Main Results: A total of 34 children with a median age of 10 years (interquartile range: 7-11 yr) underwent standard-volume TPE and/or CRRT treatments. Combined TPE and CRRT ( n = 19), versus CRRT alone ( n = 15), was associated with lower proportion of mortality 7 of 19 (37%) versus 13 of 15 (87%), difference 50% (95% CI, 22-78; p < 0.01). Use of combined TPE and CRRT was associated with substantial advancements in clinical hepatoencephalopathy, liver transaminases, coagulation profiles, and blood lactate and ammonia levels (all p values < 0.001). Conclusions: In our experience of children with dengue-associated PALF and shock syndrome, combined use of TPE and CRRT, versus CRRT alone, is associated with better outcomes. Such combination intervention was associated with normalization of liver function, neurological status, and biochemistry. In our center we continue to use combined TPE and CRRT rather than CRRT alone. Competing Interests: The authors have disclosed that they do not have any potential conflicts of interest. (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.)
Databáze:	MEDLINE
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