Department of Emergency Medicine, American University of Beirut, Beirut, Lebanon.
Intensive Care Department, Ministry of National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia.
Ann Med. 2021 Dec;53(1):1737-1743. doi: 10.1080/07853890.2021.1987511.
This study aims to examine the outcome of end-stage renal disease (ESRD) patients admitted with sepsis to the intensive care unit (ICU).
Single centre, retrospective cohort study.
The study was conducted in the Intensive Care Department of King Abdulaziz Medical City, Riyadh, Saudi Arabia.
Data were extracted from a prospectively collected ICU database from 2002 to 2017. Patients were considered to have sepsis based on the sepsis-3 definition and were stratified into 2 groups based on the presence or absence of ESRD.
The primary outcome of the study was in-hospital mortality. Secondary outcomes included ICU mortality, ICU and hospital lengths of stay, and mechanical ventilation duration.
A total of 8803 patients were admitted to the ICU with sepsis during the study period. 730 (8.3%) patients had ESRD. 49.04% of ESRD patients with sepsis died within their hospital stay vs. 31.78% of non-ESRD patients. ESRD septic patients had 1.44 greater odds of dying within their hospital stay as compared to septic non-ESRD patients (OR 1.44, 95% CI 1.03-1.53). Finally, the predictors of hospital mortality in septic ESRD patients were found to be mechanical ventilation (OR 3.36; 95% CI 2.27-5.00), a history of chronic liver disease (OR 2.26; 95% CI 1.26-4.07), and use of vasopressors (OR 1.74; 95% CI 1.19-2.54). Among patients with ESRD, hospital mortality was higher in subgroups of patients with chronic cardiac (OR 1.86 (1.36-2.53) vs. 1.19 (0.96-1.47)) and chronic respiratory illnesses (OR 2.20 (1.52-3.20) vs. 1.21 (0.99-1.48)).
ESRD patients admitted to the intensive care unit with sepsis are at greater odds of mortality compared to patients with non-ESRD. This risk is particularly increased if these patients have a concomitant history of chronic cardiac and respiratory illnesses.Key MessagesSepsis and bacterial infections are very common in ESRD patients and following cardiovascular disease; sepsis is the second leading cause of death in patients with ESRD.This study aims to examine the outcome of patients with end-stage renal disease (ESRD) patients admitted with sepsis to the intensive care unit (ICU).The results of this study have shown that end-stage renal disease is associated with greater odds of ICU and hospital mortality among septic patients admitted to an intensive care unit.ESRD patients were also more likely to be started on vasopressors and mechanical ventilation.
本研究旨在探讨因败血症入住重症监护病房（ICU）的终末期肾病（ESRD）患者的预后。
单中心、回顾性队列研究。
沙特阿拉伯利雅得阿卜杜勒阿齐兹国王医疗城的重症监护病房。
数据来自 2002 年至 2017 年期间前瞻性收集的 ICU 数据库。根据败血症-3 定义，患者被认为患有败血症，并根据是否存在 ESRD 将其分为 2 组。
本研究的主要结局为院内死亡率。次要结局包括 ICU 死亡率、ICU 和住院时间、机械通气时间。
在研究期间，共有 8803 名患者因败血症入住 ICU。730 名（8.3%）患者患有 ESRD。败血症伴 ESRD 患者的院内死亡率为 49.04%，而非 ESRD 败血症患者的院内死亡率为 31.78%。与非 ESRD 败血症患者相比，败血症伴 ESRD 患者的院内死亡风险高出 1.44 倍（OR 1.44，95%CI 1.03-1.53）。最后，发现败血症伴 ESRD 患者的住院死亡预测因素为机械通气（OR 3.36；95%CI 2.27-5.00）、慢性肝脏疾病史（OR 2.26；95%CI 1.26-4.07）和血管加压素的使用（OR 1.74；95%CI 1.19-2.54）。在患有 ESRD 的患者中，患有慢性心脏（OR 1.86（1.36-2.53）vs. 1.19（0.96-1.47））和慢性呼吸系统疾病（OR 2.20（1.52-3.20）vs. 1.21（0.99-1.48））的患者亚组的住院死亡率更高。
与非 ESRD 败血症患者相比，因败血症入住 ICU 的 ESRD 患者的死亡率更高。如果这些患者同时患有慢性心脏和呼吸系统疾病，这种风险会进一步增加。
败血症和细菌感染在 ESRD 患者中非常常见，并且紧随心血管疾病之后；败血症是 ESRD 患者的第二大死亡原因。本研究旨在探讨因败血症入住重症监护病房（ICU）的终末期肾病（ESRD）患者的预后。这项研究的结果表明，与入住 ICU 的败血症患者相比，终末期肾病与 ICU 和医院死亡率的几率增加有关。ESRD 患者也更有可能开始使用血管加压素和机械通气。
