Clinical variables associated with poor outcome from sepsis-associated acute kidney injury and the relationship with timing of initiation of renal replacement therapy
Por:
Perez-Fernandez, X, Sabater-Riera, J, Sileanu, FE, Vazquez-Reveron, J, Ballus-Noguera, J, Cardenas-Campos, P, Betbese-Roig, A, Kellum, JA
Publicada:
1 ago 2017
Resumen:
Purpose: Identify clinical variables associated with mortality in patients with sepsis-associated acute kidney injury (SA-AKI) receiving continuous renal replacement therapy (CRRT) and examine timing of initiation of CRRT in reference to those variables identified.
Methods: Retrospective study conducted at two tertiary care hospitals including 939 septic shock patients with SA-AKI who received CRRT in the intensive care unit (ICU). Cox regression models were used to identify variables associated with 90-day mortality. Timing of CRRT initiation was assessed in relationship to significant clinical variables identified.
Results: Overall 90-day mortality was 62.9%. Variables prior to CRRT associated with 90-day mortality included: age (aHR, 1.02; 95% CI, 1.01-1.02, p < 000.1), APS-III score (1.01, 1.0-1.0, p < 0.048), days from hospital admission to CRRT initiation (1.01, 1.0-1.0, p < 0.01), blood urea nitrogen (1.01, 1.0-1.0, p < 0.04), medical admission (1.76, 1.5-2.1, p < 0.0001), creatinine (0.99, 0.9-1.0, p < 0.001), and urine output (0.77, 0.6-0.9, p = 0.049). In patients with advanced SA-AKI at ICU admission receiving CRRT within the first 5 days (n = 433), urine output during the 24 h prior to CRRT initiation was a strong predictor of survival (2.6, 1.6-4.3, p < 0.001).
Conclusions: In patients with SA-AKI, survival is lower when CRRT is started in the setting of low urine output. (C) 2017 Elsevier Inc. All rights reserved.
Filiaciones:
Perez-Fernandez, X:
Hosp Univ Bellvitge, Serv Med Intens, Lhospitalet De Llobregat, Spain
Sabater-Riera, J:
Hosp Univ Bellvitge, Serv Med Intens, Lhospitalet De Llobregat, Spain
Sileanu, FE:
Univ Pittsburgh, Sch Med, Ctr Crit Care Nephrol, CRISMA,Dept Crit Care Med, Pittsburgh, PA USA
Vazquez-Reveron, J:
Hosp Univ Bellvitge, Serv Med Intens, Lhospitalet De Llobregat, Spain
Ballus-Noguera, J:
Hosp Univ Bellvitge, Serv Med Intens, Lhospitalet De Llobregat, Spain
Cardenas-Campos, P:
Hosp Univ Bellvitge, Serv Med Intens, Lhospitalet De Llobregat, Spain
Betbese-Roig, A:
Hosp Santa Creu & Sant Pau, Serv Med Intens, Barcelona, Spain
Univ Autonoma Barcelona, C St Quintin 89, Barcelona, Spain
Kellum, JA:
Univ Pittsburgh, Sch Med, Ctr Crit Care Nephrol, CRISMA,Dept Crit Care Med, Pittsburgh, PA USA
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