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接受持续肾脏替代治疗的危重症患者早期死亡的相关因素

Factors Associated with Early Mortality in Critically Ill Patients Following the Initiation of Continuous Renal Replacement Therapy.

作者信息

Kee Youn Kyung, Kim Dahye, Kim Seung-Jung, Kang Duk-Hee, Choi Kyu Bok, Oh Hyung Jung, Ryu Dong-Ryeol

机构信息

Department of Internal Medicine, Hangang Sacred Heart Hospital, Hallym University College of Medicine, Seoul 07247, Korea.

Department of Nursing, Ewha Womans University Mokdong Hospital, Seoul 07985, Korea.

出版信息

J Clin Med. 2018 Oct 8;7(10):334. doi: 10.3390/jcm7100334.

Abstract

Continuous renal replacement therapy (CRRT) is an important modality to support critically ill patients, and the need for CRRT treatment has been increasing. However, CRRT management is costly, and the associated resources are limited. Thus, it remains challenging to identify patients that are likely to have a poor outcome, despite active treatment with CRRT. We sought to elucidate the factors associated with early mortality after CRRT initiation. We analyzed 240 patients who initiated CRRT at an academic medical center between September 2016 and January 2018. We compared baseline characteristics between patients who died within seven days of initiating CRRT (early mortality), and those that survived more than seven days beyond the initiation of CRRT. Of the patients assessed, 130 (54.2%) died within seven days of CRRT initiation. Multivariate logistic regression models revealed that low mean arterial pressure, low arterial pH, and high Sequential Organ Failure Assessment score before CRRT initiation were significantly associated with increased early mortality in patients requiring CRRT. In conclusion, the mortality within seven days following CRRT initiation was very high in this study. We identified several factors that are associated with early mortality in patients undergoing CRRT, which may be useful in predicting early outcomes, despite active treatment with CRRT.

摘要

连续性肾脏替代治疗(CRRT)是支持重症患者的一种重要方式,并且对CRRT治疗的需求一直在增加。然而,CRRT管理成本高昂,且相关资源有限。因此,尽管对患者积极进行CRRT治疗,但识别可能预后不良的患者仍然具有挑战性。我们试图阐明与CRRT开始后早期死亡率相关的因素。我们分析了2016年9月至2018年1月期间在一家学术医疗中心开始接受CRRT治疗的240例患者。我们比较了在CRRT开始后七天内死亡的患者(早期死亡率)与在CRRT开始后存活超过七天的患者之间的基线特征。在所评估的患者中,130例(54.2%)在CRRT开始后七天内死亡。多因素逻辑回归模型显示,在需要CRRT治疗的患者中,CRRT开始前平均动脉压低、动脉血pH值低以及序贯器官衰竭评估评分高与早期死亡率增加显著相关。总之,在本研究中,CRRT开始后七天内的死亡率非常高。我们确定了几个与接受CRRT治疗患者的早期死亡率相关的因素,这些因素可能有助于预测早期预后,尽管对患者积极进行了CRRT治疗。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3153/6210947/efd94e7596d4/jcm-07-00334-g001.jpg

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