Thrombocytopenia in Children and Young Adults Undergoing Continuous Renal Replacement Therapy: A WE-ROCK Study
Bibliographic record
Abstract
INTRODUCTION: Thrombocytopenia in patients treated with continuous renal replacement therapy (CRRT) in adults is associated with mortality. Pediatric data are limited. The association between pre-CRRT thrombocytopenia and platelet decline at 24 h of CRRT with outcomes was evaluated. METHODS: Secondary analysis of the Worldwide Exploration of Renal Replacement Outcomes Collaborative in Kidney Disease (WE-ROCK) includes patients' birth-25 years who underwent CRRT. Exclusions were end-stage kidney disease, non-acute kidney injury/fluid overload CRRT indication, concurrent extracorporeal membrane oxygenation, missing baseline platelets, platelet disorders, and hematologic malignancy. Primary exposures were (i) pre-CRRT thrombocytopenia (≤100 × 103/μL) and (ii) ≥30% decline at 24 h of CRRT in those with pre-CRRT >100 × 103/μL. Primary outcome was survival to intensive care unit (ICU) discharge. Secondary outcomes included major adverse kidney events at 90 days (MAKE-90) (death, dialysis dependence, creatinine >125% baseline) from CRRT initiation. RESULTS: A total of 805 patients were included. Overall, 63.9% had baseline thrombocytopenia, median (IQR) platelets of 38 (20, 63) ×103/μL. Baseline thrombocytopenia occurred in younger septic patients with higher illness severity. A ≥30% decline occurred in 33% of patients. Those with a ≥30% platelet decline were more commonly younger patients and had smaller catheters. Pre-CRRT thrombocytopenia and platelet decline were associated with ICU mortality in univariate but not multivariate models. There was no association with MAKE-90. CONCLUSIONS: Thrombocytopenia is common prior to CRRT initiation and is associated with greater illness severity. These findings stress the importance of vigilant monitoring of platelet levels before CRRT initiation and during therapy as thrombocytopenia at both time points may be a prognostic indicator. Additionally, this study highlights the need for future research to clarify the interplay of patient and mechanical factors in this phenomenon and guide potential interventions.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.003 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".