2651OhioHealth Doctors Hospital, Columbus, OH, USA.
6595University of Pittsburgh, Pittsburgh, PA, USA.
J Intensive Care Med. 2022 Aug;37(8):1043-1048. doi: 10.1177/08850666211052871. Epub 2021 Nov 23.
Continuous renal replacement therapy (CRRT) is commonly used in critically ill, hemodynamically unstable patients with acute kidney injury (AKI). This procedure is resource intensive with reported high in-hospital mortality. We evaluated mortality with CRRT in our healthcare system and markers associated with decreased survival.
A retrospective cohort study collected data on patients 18 years or older, without prior history of end stage kidney disease (ESKD), who received CRRT in the intensive care units at one of three hospitals in our health system in Columbus, OH from July 1, 2016 to July 1, 2019. Data included demographics, presenting diagnosis, comorbidities, laboratory markers, and patient disposition. In-hospital mortality rates and sequential organ failure assessment (SOFA) scores were calculated. We then compared information between two groups (patients who died during hospitalization and survivors) using univariate comparisons and multivariate logistic regression models.
In-hospital mortality was 56.8% (95%CI: 53.4-60.1) among patients who received CRRT. Mean SOFA scores did not differ between survival and mortality groups. The odds for in-patient mortality were increased for patients age ≥60 (OR = 1.74, 95%CI: 1.23-2.44), first bilirubin >2 mg/dL (OR = 1.73, 95%CI: 1.12-2.69), first creatinine < 2 mg/dL (OR = 1.57, 95%CI: 1.04-2.37), first lactate > 2 mmol/L (OR = 2.08, 95%CI: 1.43-3.04). The odds for in-patient mortality were decreased for patients with cardiogenic shock (OR = .32, 95%CI: .17-.58) and hemorrhagic shock (OR = .29, 95%CI: .13-.63).
We report in-hospital mortality rates of 56.8% with CRRT. Unlike prior studies, higher mean SOFA scores were not predictive of higher in-hospital mortality in patients utilizing CRRT.
连续肾脏替代疗法（CRRT）常用于血流动力学不稳定的急性肾损伤（AKI）危重症患者。该治疗方法资源消耗大，据报道院内死亡率较高。我们评估了在我院医疗系统中使用 CRRT 的患者的死亡率以及与生存率降低相关的标志物。
回顾性队列研究收集了 2016 年 7 月 1 日至 2019 年 7 月 1 日在俄亥俄州哥伦布市我院三家医院重症监护病房接受 CRRT 的年龄在 18 岁及以上、无终末期肾病（ESKD）既往史的患者数据。数据包括人口统计学资料、入院诊断、合并症、实验室标志物和患者去向。计算院内死亡率和序贯器官衰竭评估（SOFA）评分。然后，我们使用单变量比较和多变量逻辑回归模型比较了两组（住院期间死亡的患者和幸存者）之间的信息。
接受 CRRT 的患者院内死亡率为 56.8%（95%CI：53.4-60.1）。存活组和死亡组的平均 SOFA 评分无差异。年龄≥60 岁（OR=1.74，95%CI：1.23-2.44）、首次胆红素>2mg/dL（OR=1.73，95%CI：1.12-2.69）、首次肌酐<2mg/dL（OR=1.57，95%CI：1.04-2.37）、首次乳酸>2mmol/L（OR=2.08，95%CI：1.43-3.04）的患者住院死亡率的几率增加。心源性休克（OR=0.32，95%CI：0.17-0.58）和失血性休克（OR=0.29，95%CI：0.13-0.63）患者的住院死亡率几率降低。
我们报告 CRRT 的院内死亡率为 56.8%。与既往研究不同，接受 CRRT 的患者中，较高的平均 SOFA 评分并不能预测较高的院内死亡率。
