Facteurs prédictifs des patients cirrhotiques en réanimation pédiatrique, greffés exclus. Étude rétrospective non interventionnelle multicentrique

Abstract : Data on pediatric intensive care unit (PICU)-admitted cirrhotic patients is scarce. We aimed to evaluate the (i) prognosis and (ii) predictive factors for 28-day and 60-day poor outcome (eg mortality, liver transplantation) in children admitted in PICU without previous liver transplantation. We performed a multicentric retrospective analysis of pediatric cirrhosis patients admitted into four critical care units between 2011-2016 (ESPNIC research network group). We recorded clinical and biological data at admission then day 7 and followed the patients until discharge. Pediatric index of mortality (PIM2), RIFLE score (acute renal failure), Pediatric End-Stage Liver Disease score (PELD) and pediatric chronic liver failure sequential organ failure assessment score (pCLIF SOFA) were computed during ICU stay. Univariate and multivariate analysis were carried out to identify the best predictors of poor outcome. A total of 130 patients were enrolled (mean age of 21 months) and 51% had a poor outcome at 60-day. Significant risk factors for poor outcome were high international normalized ratio (OR 3.11 IC95% [1.4-6.78] p=0.004), bilirubin (OR 3.5 IC95%[1.54-8.05] p=0.003), acute-on-chronic liver failure (ACLF) (OR 5.8 IC95% [1.86-18.32] p=0.002), renal failure (OR 34 IC95%[4.45-268] p=0.001) and sepsis (OR 2.7 IC95%[1.35-5.62] p=0.005). pCLIF-SOFA showed the best AUC of 0.83 (IC95% [0.74-0.92] p=0.04) and with a score of ≥ 9 well predicted a 28-day mortality with a sensitivity of 87.8% and a specificity of 77.3%. Neither the Pediatric Index of Mortality score (PIM2) or the Pediatric End-Stage Liver Disease score (PELD) score were discriminant (AUC of 0.76 (IC95% [0.64-0.86])) whereas the RIFLE score (Risk of renal dysfunction, Injury, Failure, Loss, End-stage) was significantly associated to mortality at day-28 (Failure: OR 18 (IC95% [6.0-55] p=0.000). Fifty one percent of cirrhosis pediatric patients admitted in PICU have a poor outcome. Sepsis and acute-onchronic liver failure are independent predictors of outcome. pCLIF-SOFA is a reliable score in prognostication of 28 mortality or 60- day poor outcome.
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Master Thesis
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Caroline Claude. Facteurs prédictifs des patients cirrhotiques en réanimation pédiatrique, greffés exclus. Étude rétrospective non interventionnelle multicentrique. Médecine humaine et pathologie. 2018. ⟨dumas-02180731⟩

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