Supplementary Material for: Use of the Selective Cytopheretic Device with Continuous Renal Replacement Therapy in Children: A Comparison of Contemporary Cohorts

Introduction: The Selective Cytopheretic Device (SCD) is a cell-directed extracorporeal therapy approved for use in children with acute kidney injury (AKI) receiving continuous renal replacement therapy (CRRT) with sepsis/sepsis-like conditions. We compared outcomes for children treated with SCD to a contemporary cohort of children treated with CRRT alone.
Methods: Secondary analysis and comparison of patients ≤22 years old and ≥10 kg from a multicenter registry of patients receiving CRRT for AKI and/or fluid overload (WE-ROCK; 2015-2021) to patients from two multicenter, prospective, interventional studies of children with AKI and multiple organ dysfunction (MODS) receiving SCD (SCD-PED-01/SCD-PED-02; 2016-2022).
Results: Eighteen patients in the SCD Cohort were compared to 178 in the CRRT Cohort. There were no differences between cohorts at CRRT+/-SCD initiation. SCD patients had shorter CRRT duration (6 [3,11] vs. 10 [5,18] days, p=0.013) and shorter ICU length of stay (LOS) in survivors (16 [11,25] vs. 27 [16,46] days, p=0.012). Survival to ICU discharge or Day 60 was 94% in the SCD Cohort vs. 74% in the CRRT Cohort (p=0.079). A Bayesian analysis demonstrated a >99% probability of improved survival with SCD. A sub-analysis in septic patients demonstrated greater survival (100% vs. 69%, p=0.032), shorter CRRT duration (5 [3,7] vs. 11 [6,17] days, p=0.006) and reduced ICU LOS in survivors (21 [10,25] vs. 27 [16,45] days, p=0.027) in SCD-treated patients.
Conclusions: The addition of SCD therapy in children with AKI and MODS receiving CRRT may be beneficial, though larger prospective studies are needed.

引言：选择性细胞过滤装置（Selective Cytopheretic Device, SCD）是一种以细胞为导向的体外治疗手段，已获批用于合并脓毒症/类脓毒症状态且接受连续性肾脏替代治疗（continuous renal replacement therapy, CRRT）的急性肾损伤（acute kidney injury, AKI）患儿。本研究将接受SCD治疗的患儿与同期仅接受CRRT治疗的患儿队列进行了转归对比。
方法：本研究为二次分析，纳入2015-2021年多中心AKI和/或液体超负荷CRRT治疗患者登记库（WE-ROCK）中年龄≤22岁、体重≥10kg的患者，与2016-2022年两项针对AKI合并多器官功能障碍综合征（multiple organ dysfunction, MODS）患儿的多中心前瞻性干预研究（SCD-PED-01/SCD-PED-02）中接受SCD治疗的患者进行对比。
结果：SCD队列共纳入18例患者，CRRT队列纳入178例患者。两组在启动CRRT±SCD治疗时的基线特征无显著差异。SCD组患儿的CRRT治疗时长更短：6[3,11]天 vs 10[5,18]天，p=0.013；存活患儿的ICU住院时长（length of stay, LOS）更短：16[11,25]天 vs 27[16,46]天，p=0.012。至ICU出院或第60天的生存率方面，SCD组为94%，CRRT组为74%（p=0.079）。贝叶斯分析显示，SCD治疗可改善生存结局的概率超过99%。脓毒症患者亚组分析显示，接受SCD治疗的患者生存率更高（100% vs 69%，p=0.032），CRRT治疗时长更短（5[3,7]天 vs 11[6,17]天，p=0.006），且存活患儿的ICU住院时长更短：21[10,25]天 vs 27[16,45]天，p=0.027。
结论：对于接受CRRT治疗的AKI合并MODS患儿，加用SCD治疗或可带来获益，但仍需开展更大样本量的前瞻性研究予以验证。