Tatum James M, Barmparas Galinos, Ko Ara, Dhillon Navpreet, Smith Eric, Margulies Daniel R, Ley Eric J
Division of Trauma and Critical Care, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California.
JAMA Surg. 2017 Oct 1;152(10):938-943. doi: 10.1001/jamasurg.2017.1673.
Continuous renal replacement therapy (CRRT) benefits patients with renal failure who are too hemodynamically unstable for intermittent hemodialysis. The duration of therapy beyond which continued use is futile, particularly in a population of patients admitted to and primarily cared for by a surgical service (hereinafter referred to as surgical patients), is unclear.
To analyze proportions of and independent risk factors for survival to discharge after initiation of CRRT among patients in a surgical intensive care unit (SICU).
DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study included all patients undergoing CRRT from July 1, 2012, through January 31, 2016, in an SICU of an urban tertiary medical center. The population included patients treated before or after general surgery and patients admitted to a surgical service during inpatient evaluation and care before liver transplant. The pretransplant population was censored from further survival analysis on receipt of a transplant.
Continuous renal replacement therapy.
Hospital mortality among patients in an SICU after initiation of CRRT.
Of 108 patients (64 men [59.3%] and 44 women [40.7%]; mean [SD] age, 62.0 [12.7] years) admitted to the SICU, 53 were in the general surgical group and 55 in the pretransplant group. Thirteen of the 22 patients in the pretransplant group who required 7 or more days of CRRT died (in-hospital mortality, 59.1%); among the 12 patients in the general surgery group who required 7 or more days of CRRT, 12 died (in-hospital mortality, 100%). In the general surgical group, each day of CRRT was associated with an increased adjusted odds ratio of death of 1.39 (95% CI, 1.01-1.90; P = .04).
Continuous renal replacement therapy is valuable for surgical patients with an acute and correctable indication; however, survival decreases significantly with increasing duration of CRRT. Duration of CRRT does not correlate with survival among patients awaiting liver transplant.
连续性肾脏替代治疗（CRRT）对因血流动力学不稳定而无法进行间歇性血液透析的肾衰竭患者有益。然而，对于治疗持续多长时间后继续使用徒劳无益，尤其是在由外科服务团队收治并主要接受其护理的患者群体（以下简称外科患者）中，目前尚不清楚。
分析外科重症监护病房（SICU）患者开始CRRT后出院生存的比例及独立危险因素。
设计、设置和参与者：这项回顾性队列研究纳入了2012年7月1日至2016年1月31日期间在一家城市三级医疗中心的SICU接受CRRT的所有患者。该人群包括普通外科手术前后接受治疗的患者以及在肝移植住院评估和护理期间入住外科服务团队的患者。移植前人群在接受移植后从进一步的生存分析中被截尾。
连续性肾脏替代治疗。
SICU患者开始CRRT后的医院死亡率。
在108例入住SICU的患者中（64例男性[59.3%]，44例女性[40.7%]；平均[标准差]年龄为62.0[12.7]岁），53例在普通外科组，55例在移植前组。移植前组中22例需要CRRT 7天或更长时间的患者中有13例死亡（院内死亡率为59.1%）；在普通外科组中12例需要CRRT 7天或更长时间的患者中，12例死亡（院内死亡率为100%）。在普通外科组中，CRRT的每一天都与死亡的调整后比值比增加1.39相关（95%CI，1.01 - 1.90；P = 0.04）。
连续性肾脏替代治疗对于有急性且可纠正适应症的外科患者有价值；然而，随着CRRT持续时间的增加，生存率显著下降。CRRT的持续时间与等待肝移植患者的生存率无关。
