Analysis of risk factors for death in 59 cases of critically ill neonates receiving continuous renal replacement therapy-a two-center retrospective study

Abstract

Objective: To investigate the risk factors for death in critically ill neonates receiving continuous renal replacement therapy (CRRT). Methods: The clinical data of critically ill neonates treated with CRRT at two tertiary hospitals from January 2015 to December 2021 were retrospectively analysed. A multi-factor logistic regression analysis was performed, and the predictive value of relevant risk factors on death was verified by receiver operating characteristic (ROC) curve. Results: (1) A total of 59 cases of critically ill neonates were included in this study, with 37 cases in the survival group and 22 in the death group. The mortality rate was 37.3%. (2) The most common primary disease in these cases was neonatal sepsis, followed by neonatal asphyxia and inborn errors of metabolism (IEM). (3) Univariate analysis showed that the risk factors related to death included primary diseases (neonatal sepsis, IEM), the number of organs involved in multiple organ dysfunction syndrome (MODS), neonatal critical illness scores (NCIS), the levels of blood lactate, blood glucose, hemoglobin, and platelet before CRRT initiation, and the incidence of bleeding or thrombosis during CRRT (all P<0.05). (4) Multi-factor logistic regression analysis showed that risk factors for death in critically ill neonates treated with CRRT included the occurrence of neonatal sepsis (OR=8.859, 95% CI 1.165 to 67.384, P=0.035), the number of organs involved in MODS (OR=4.762, 95% CI 1.301 to 17.424, P= 0.018), and the NCIS (OR=0.819, 95% CI 0.715 to 0.938, P=0.004). (5) ROC curve analysis showed that the number of organs involved in MODS and NCIS had a good predictive value for death in critically ill neonates treated with CRRT, with the areas under the curve (AUC) being 0.700 and 0.810, respectively (both P<0.05). When predicting death with these two indicators combined, the AUC reached 0.890, with a sensitivity of 81.0% and a specificity of 88.9%. Conclusions: Neonatal sepsis, number of organs involved in MODS, and NCIS were independent risk factors for death in critically ill neonates treated with CRRT. Moreover, the number of organs involved in MODS and NCIS could effectively predict death in critically ill neonates treated with CRRT.