Soubrier Stéphane, Leroy Olivier, Devos Patrick, Nseir Saad, Georges Hugues, d'Escrivan Thibaud, Guery Benoit
Service de Réanimation Médicale, Hôpital Calmette, CHRU, 59037 Lille Cedex, France.
J Crit Care. 2006 Mar;21(1):66-72. doi: 10.1016/j.jcrc.2005.08.004.
The objective of this study is to study the epidemiology, outcome, and prognostic factors of critically ill patients treated with continuous venovenous hemodiafiltration (CVVHDF).
Observational cohort was done in a French 16-bed intensive care unit (ICU) from a university-affiliated urban hospital. All patients requiring, in the opinion of the treating physician, the initiation of CVVHDF were included in the study.
One hundred ninety-seven patients with acute renal failure (ARF) treated with CVVHDF were studied. The incidence of ARF treated with CVVHDF was 5.9% in the ICU with a mortality rate of 71.6%. A multivariate analysis identified 3 independent factors associated with fatal outcome: mechanical ventilation, sepsis, and septic shock requiring vasoactive drug. In contrast, 2 independent factors predicted a favorable outcome: nonoliguric ARF and serum creatinine concentration higher than 34 mg/L at CVVHDF initiation. A flowchart determined by the chi2 Automatic Interaction and Detection statistical method allowed for the identification of patients' subgroups with different mortality rates ranging from 25% to 100%.
In our series, ARF treated with CVVHDF was associated with a high overall ICU mortality rate (71.6%). However, our prognostic flowchart identified patients with low mortality rates for which renal replacement therapy must be initiated with no discussion as soon as required.
本研究旨在探讨接受持续静静脉血液透析滤过（CVVHDF）治疗的危重症患者的流行病学、治疗结果及预后因素。
在一所大学附属医院的拥有16张床位的法国重症监护病房（ICU）进行观察性队列研究。所有经主治医生判断需要启动CVVHDF治疗的患者均纳入本研究。
对197例接受CVVHDF治疗的急性肾衰竭（ARF）患者进行了研究。在ICU中，接受CVVHDF治疗的ARF发病率为5.9%，死亡率为71.6%。多因素分析确定了3个与致命结局相关的独立因素：机械通气、脓毒症以及需要血管活性药物治疗的感染性休克。相比之下，2个独立因素预示着良好的结局：非少尿型ARF以及CVVHDF开始时血清肌酐浓度高于34mg/L。通过卡方自动交互检测统计方法确定的流程图能够识别死亡率在25%至100%之间的不同患者亚组。
在我们的研究系列中，接受CVVHDF治疗的ARF与ICU总体高死亡率（71.6%）相关。然而，我们的预后流程图识别出了死亡率较低且一旦需要应立即启动肾脏替代治疗而无需讨论的患者。
