Pornsirirat Thonnarat, Kasemvilawan Nualnapa, Pattanacharoenwong Patcharavalia, Arpibanwana Saisunee, Kondon Hatairat, Naorungroj Thummaporn
Division of Intensive Care, Department of Nursing, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Division of Intensive Care, Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Acute Crit Care. 2024 Aug;39(3):379-389. doi: 10.4266/acc.2024.00038. Epub 2024 Aug 12.
Hypothermia is a relatively common complication in patients receiving continuous renal replacement therapy (CRRT). However, few studies have reported the factors associated with hypothermia.
A retrospective cohort study was performed in five intensive care units (ICUs) to evaluate the incidence of hypothermia and the predictive factors for developing hypothermia during CRRT, with hypothermia defined as a time-weighted average temperature <36 °C.
From January 2020 to December 2021, 300 patients were enrolled. Hypothermia developed in 23.7% of them within the first 24 hours after CRRT initiation. Compared to non-hypothermic patients, hypothermic patients were older and had lower body weight, more frequent acidemia, and higher ICU and 30-day mortality rates. In the multivariate analysis, age >70 years (odds ratio [OR], 2.59; 95% CI, 1.38-4.98; P=0.004), higher positive fluid balance on the day before CRRT (OR, 1.11; 95% CI, 1.02-1.22; P=0.02), and CRRT dose (OR, 1.003; 95% CI, 1.00-1.01; P=0.04) were significantly associated with hypothermia. Conversely, a higher body weight was independently associated with mitigated risk of hypothermia (OR, 0.89; 95% CI, 0.81-0.97; P=0.01). Moreover, a higher coefficient of variance of temperature was associated with greater ICU mortality (OR, 1.41; 95% CI, 1.13-1.78; P=0.003).
Hypothermia during CRRT is a relatively common occurrence, and factors associated with hypothermia onset in the first 24 hours include older age, lower body weight, higher positive fluid balance on the day before CRRT, and higher CRRT dose. Greater temperature variability was associated with increased ICU mortality.
体温过低是接受持续肾脏替代治疗（CRRT）患者中较为常见的并发症。然而，很少有研究报道与体温过低相关的因素。
在五个重症监护病房（ICU）进行了一项回顾性队列研究，以评估CRRT期间体温过低的发生率及发生体温过低的预测因素，体温过低定义为时间加权平均温度<36°C。
2020年1月至2021年12月，共纳入300例患者。其中23.7%的患者在CRRT开始后的最初24小时内出现体温过低。与非体温过低患者相比，体温过低患者年龄更大、体重更低、酸血症更频繁，ICU死亡率和30天死亡率更高。多因素分析显示，年龄>70岁（比值比[OR]，2.59；95%置信区间[CI]，1.38 - 4.98；P = 0.004）、CRRT前一天较高的正液体平衡（OR，1.11；95% CI，1.02 - 1.22；P = 0.02）以及CRRT剂量（OR，1.003；95% CI，1.00 - 1.01；P = 0.04）与体温过低显著相关。相反，较高的体重与体温过低风险降低独立相关（OR，0.89；95% CI，0.81 - 0.97；P = 0.01）。此外，温度变异系数越高，ICU死亡率越高（OR，1.41；95% CI，1.13 - 1.78；P = 0.003）。
CRRT期间体温过低较为常见，CRRT开始后24小时内与体温过低发生相关的因素包括年龄较大、体重较低、CRRT前一天较高的正液体平衡以及较高的CRRT剂量。更大的温度变异性与ICU死亡率增加相关。
