OUTCOMES OF CONTINUOUS RENAL REPLACEMENT THERAPY IN CHILDREN WITH SEVERE MEASLES COMPLICATIONS AT VIETNAM NATIONAL CHILDREN’S HOSPITAL
##plugins.themes.vojs.article.main##
Abstract
Measles complicated by septic shock and multiple organ failure (MOF) in children is a life-threatening condition associated with high mortality. This retrospective case series evaluates 43 pediatric patients with severe measles complications requiring continuous renal replacement therapy (CRRT) at the Center for Tropical Diseases, Vietnam National Children's Hospital, between 2024 and 2026. At CRRT initiation, all patients presented with septic shock and MOF (median of 3 failing organs; median PRISM III score of 11), with 88.4% developing pediatric acute respiratory distress syndrome (PARDS) and 25.6% exhibiting early positive fluid balance. Following CRRT, the Vasoactive-Inotropic Score (VIS) significantly declined from a median of 20 to 5.5 at 48 hours (p=0.031) and to 0 at 72 hours (p=0.016). The oxygenation index (OI) improved from 23.82 to 15.11 at 72 hours (p=0.004), alongside a substantial reduction in serum interleukin-6 (IL-6) levels from 238pg/mL to 38.35pg/mL at 72 hours (p<0.001). The median duration of CRRT was 5 days. Filter clotting and hypokalemia were the most frequent complications, each accounting for 41.9%. The overall ICU survival rate was 51.2%. Notably, there was no statistically significant difference in the timing of CRRT initiation between survivors and non-survivors. Preliminary findings suggest that CRRT was associated with improved oxygenation, reduced vasopressor requirements, improved hemodynamic status, and decreased IL-6 levels.
##plugins.themes.vojs.article.details##
Keywords
Severe measles, Continuous renal replacement therapy, Multiple organ dysfunction syndrome
References
2. Lin WHW, Nelson AN, Ryon JJ et al. Plasma cytokines and chemokines in Zambian children with measles: innate responses and association with HIV-1 coinfection and in-hospital mortality. J Infect Dis 2017;215(5):830-839. https://doi.org/10.1093/infdis/jix012
3. Đặng Khánh Ly, Đinh Trọng Hùng, Đỗ Thiện Hải. Đặc điểm dịch tễ, lâm sàng, cận lâm sàng ở trẻ mắc sởi được điều trị immunoglobulin tiêm tĩnh mạch. Tạp chí Y học Cộng đồng, 2026; 67(CĐ11-NCKH). https://doi.org/10.52163/yhc.v67iCD11.6075
4. Teixeira JP, Hiremath S, Kabli AO et al. Continuous kidney replacement therapies: core curriculum 2025. Am J Kidney Dis 2025;85(6):767-786. https://doi.org/10.1053/j.ajkd.2024.09.015
5. Schlapbach LJ, Watson RS, Sorce LR et al. International Consensus Criteria for Pediatric Sepsis and Septic Shock. JAMA 2024;331(8):665-674. http://doi.org/10.1001/jama.2024.0179
6. Weiss SL, Carcillo JA, Leclerc F et al. Refining the Pediatric Multiple Organ Dysfunction Syndrome. Pediatrics 2022;149(1 Suppl 1):S13-S22. https://doi.org/10.1542/peds.2021-052888c
7. Selewski DT, Barhight MF, Bjornstad EC et al. Fluid assessment, fluid balance, and fluid overload in sick children: a report from the Pediatric Acute Disease Quality Initiative (ADQI) conference. Pediatr Nephrol 2024;39(3):955-979. https://doi.org/10.1007/s00467-023-06156-w
8. Executive Summary of the Second International Guidelines for the Diagnosis and Management of Pediatric Acute Respiratory Distress Syndrome (PALICC-2): Erratum. Pediatric Critical Care Medicine, 2024;25(3):e175. https://doi.org/10.1097/pcc.0000000000003473
9. Zeng S, Cui S, Li Y et al. New Insights on Continuous Renal Replacement Therapy for Acute Respiratory Distress Syndrome: A Systematic Review and Meta-Analysis. Clin Respir J 2025;19(1):e70045. https://doi.org/10.1111/crj.70045
10. Tống Duy Phúc, Trần Bá Dũng, Đậu Việt Hùng và cộng sự. Thay đổi huyết động và nội môi sau lọc máu liên tục ở trẻ sốc nhiễm trùng tại Bệnh viện Nhi Trung ương. Tạp chí Khoa học ĐHQGHN: Khoa học Y Dược, 2023;39(3):101-107.