Siddiqui Abdul Hasan, Valecha Gautam, Modi Jwalant, Saqib Amina, Weerasinghe Chanudi, Siddiqui Faraz, El Sayegh Suzanne
Pulmonary and Critical Care Medicine, University of Illinois Urbana Champaign, Champaign, USA.
Hematology-Oncology, Staten Island University Hospital, Staten Island, USA.
Cureus. 2020 May 18;12(5):e8175. doi: 10.7759/cureus.8175.
Purpose In the intensive care unit (ICU), acute renal failure is mostly part of multiple organ dysfunction syndromes with mortality ranging from 28%-90%, continuous renal replacement therapy (CRRT) is the predominant mode of RRT used in ICU. The main objective of the study was to evaluate the outcomes in patients with acute kidney injury (AKI) on CRRT in the ICU. Methods A retrospective chart review was conducted for all ICU patients with acute renal failure on CRRT in a tertiary care teaching hospital. A subgroup analysis was conducted between 15 days in hospital survivors and non-survivors to look for predictors of survival for patients on CRRT. Results Two-hundred twenty-six patients underwent CRRT from January 2007 to December 2013. The overall in-hospital mortality was 84.1%. Fifty-six patients (24.77%) survived to the 15-day post-CRRT mark. Acute respiratory failure requiring mechanical ventilation was associated with significantly increased mortality; 89.2% vs. 97.6% (P=0.008), ICU length of stay was significantly longer in the survivor group than the nonsurvivor group. Median±IQR; {20±24 vs 6±7(P: <0.0001)} and so were the ventilator-associated days {16±24 vs 4±6.5 (P: <0.0001)} and duration of CRRT {4.5±5.5 vs 2±2.0(P: <0.0001)}. Patients who survived had a lower incidence of metabolic acidosis {44.6% vs 62.9% (P: 0. 016)} and uremic encephalopathy {12.5% vs 26.5%; (P: 0.031)} but a greater incidence of volume overload {28.6% vs 15.9% (P: 0.031)} as compared to the non-survivor. Acute Physiology And Chronic Health Evaluation II (APACHE II) scores were significantly higher in the non-survivor group (mean SD) 26.9±28.0 vs. 23.9±25.8 (P: 0.0136). Conclusions This observational study in patients undergoing CRRT in an ICU setting revealed that the overall mortality was 84.1%. Fluid overload as an indication of CRRT was associated with improved 15 days' survival whereas higher APACHE II scores and the use of mechanical ventilation were associated with reduced 15 days' survival.
目的 在重症监护病房（ICU），急性肾衰竭多为多器官功能障碍综合征的一部分，死亡率在28%至90%之间，连续性肾脏替代治疗（CRRT）是ICU中使用的主要肾脏替代治疗模式。本研究的主要目的是评估ICU中接受CRRT治疗的急性肾损伤（AKI）患者的预后。方法 对一家三级护理教学医院中所有接受CRRT治疗的急性肾衰竭ICU患者进行回顾性病历审查。对住院15天的幸存者和非幸存者进行亚组分析，以寻找CRRT患者生存的预测因素。结果 2007年1月至2013年12月期间，226例患者接受了CRRT治疗。总体住院死亡率为84.1%。56例患者（24.77%）存活至CRRT后15天。需要机械通气的急性呼吸衰竭与死亡率显著增加相关；89.2%对97.6%（P = 0.008），幸存者组的ICU住院时间明显长于非幸存者组。中位数±四分位间距；{20±24对6±7（P：<0.0001）}，机械通气相关天数{16±24对4±6.5（P：<0.0001）}和CRRT持续时间{4.5±5.5对2±2.0（P：<0.0001）}也是如此。与非幸存者相比，存活患者代谢性酸中毒{44.6%对62.9%（P：0.016）}和尿毒症脑病{12.5%对26.5%；（P：0.031）}的发生率较低，但容量超负荷的发生率较高{28.6%对15.9%（P：0.031）}。非幸存者组的急性生理与慢性健康状况评估II（APACHE II）评分显著更高（均值±标准差）26.9±28.0对23.9±25.8（P：0.0136）。结论 这项针对ICU中接受CRRT治疗患者的观察性研究表明，总体死亡率为84.1%。作为CRRT指征的液体超负荷与15天生存率提高相关，而较高的APACHE II评分和机械通气的使用与15天生存率降低相关。
