Mortality predictors in critically ill patients with acute kidney injury requiring continuous renal replacement therapy

Kidney Research and Clinical Practice

Dong-Ryeol Ryu¹  Jung Nam An²  Jung Pyo Lee³  Jong Cheol Jeong⁴  Kristianne Rachel P. Medina-Liabres⁴  Sejoong Kim⁵  Dong Ki Kim⁵  Hyung Jung Oh⁶ 

[1] Department of Internal Medicine, Ewha Womans University, Seoul, Republic of Korea;Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea;Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Republic of Korea;Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea;Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea;Ewha Institute of Convergence Medicine, Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea;

关键词: acute kidney injury;    continuous renal replacement therapy;    critical illness;    mortality;   

DOI  :  10.23876/j.krcp.20.205

来源: DOAJ

【 摘 要 】

Background Because of high cost of continuous renal replacement therapy (CRRT) and the high mortality rate among severe acute kidney injury patients, careful identification of patients who will benefit from CRRT is warranted. This study determined factors associated with mortality among critically ill patients requiring CRRT. Methods This was a retrospective observational study of 414 patients admitted to the intensive care unit of four hospitals in South Korea who received CRRT from June 2017 to September 2018. Patients were divided according to degree of fluid overload (FO) and disease severity. The Cox proportional hazards model was used to explore the effect of relevant variables on mortality. Results In-hospital mortality rate was 57.2%. Ninety-day mortality rate was 58.5%. Lower creatinine and blood pH were significant predictors of mortality. A one-unit increase in the Sequential Organ Failure Assessment (SOFA) score was associated with increased risk of and 90-day mortality (hazard ratio [HR], 1.07; p < 0.001). The risk of 90-day mortality in FO patients was 57.2% (p < 0.001) higher than in those without FO. High SOFA score was associated with increased risk for 90-day mortality (HR, 1.79; p = 0.03 and HR, 3.05; p = 0.001) in patients without FO and with FO ≤ 10%, respectively. The highest mortality rates were in patients with FO > 10%, independent of disease severity. Conclusion FO increases the risk of mortality independent of other factors, including severity of acute illness. Prevention of FO should be a priority, especially when managing the critically ill.

【 授权许可】

Unknown