Short, and long-term mortality among cardiac intensive care unit patients started on continuous renal replacement therapy

Published on Feb 1, 2020in Journal of Critical Care3.425
· DOI :10.1016/J.JCRC.2019.11.001
Vasken Keleshian1
Estimated H-index: 1
(Mayo Clinic),
Kianoush Kashani43
Estimated H-index: 43
(Mayo Clinic)
+ 2 AuthorsJacob C. Jentzer25
Estimated H-index: 25
(Mayo Clinic)
Sources
Abstract
Abstract Purpose Patients requiring continuous renal replacement therapy (CRRT) are at high risk of death. Predictors of hospital mortality and post-discharge survival in cardiac intensive care unit (CICU) patients requiring CRRT have not been reported. Materials and methods Retrospective review of 198 CICU patients undergoing CRRT from 2006 to 2015. Multivariable regression identified predictors of hospital mortality and Cox proportional-hazards identified predictors of post-discharge mortality among hospital survivors. Results The indication for CRRT was volume overload in 129 (65%) and metabolic abnormalities in 76 (38%). 105 (53%) subjects died in hospital, with 22% dialysis-free hospital survival. Cardiogenic shock was present in 159 (80%) subjects; 150 (76%) subjects received vasopressors and 101 (51%) subjects required mechanical ventilation. Hospital mortality was similar in cardiogenic and non-cardiogenic causes of CICU admission. Predictors of hospital death included semi-quantitative RV function, Braden score, VIS, and PaO2/FIO2 ratio. Median post-discharge Kaplan-Meier survival was 1.9 years. Predictors of post-hospital death included age, VIS, diabetes, Braden score, semi-quantitative RV function, prior heart failure, and dialysis dependence. The indication for CRRT was not predictive of survival. Conclusion Mortality is high among CICU patients requiring CRRT, and is predicted by the Braden score, RV dysfunction, respiratory failure and vasopressor load.
References40
Newest
#1Jacob C. Jentzer (Mayo Clinic)H-Index: 25
#2Nandan S. Anavekar (Mayo Clinic)H-Index: 26
Last. Gregory W. Barsness (Mayo Clinic)H-Index: 41
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Abstract Objective To determine whether a low Braden skin score (BSS), reflecting increased risk for skin pressure injury, would predict lower survival in cardiac intensive care unit (CICU) patients after adjustment for illness severity and comorbidities. Patients and Methods This retrospective cohort study included consecutive unique adult patients admitted to a single tertiary care referral hospital CICU from January 1, 2007, through December 31, 2015, who had a BSS documented on CICU admissio...
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#1Adeel Rafi Ahmed (University Hospital Galway)H-Index: 2
#2Ayanfeoluwa Obilana (University Hospital Galway)H-Index: 1
Last. David Lappin (University Hospital Galway)H-Index: 3
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Renal replacement therapy (RRT) is frequently required to manage critically ill patients with acute kidney injury (AKI). There is limited evidence to support the current practice of RRT in intensive care units (ICUs). Recently published randomized control trials (RCTs) have further questioned our understanding of RRT in critical care. The optimal timing and dosing continues to be debatable; however, current evidence suggests delayed strategy with less intensive dosing when utilising RRT. Various...
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#1Kianoush KashaniH-Index: 43
#2Mitchell H. Rosner (University of Virginia Health System)H-Index: 52
Last. Vin-Cent Wu (NTU: National Taiwan University)H-Index: 52
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AKI is a global concern with a high incidence among patients across acute care settings. AKI is associated with significant clinical consequences and increased health care costs. Preventive measures, as well as rapid identification of AKI, have been shown to improve outcomes in small studies. Providing high-quality care for patients with AKI or those at risk of AKI occurs across a continuum that starts at the community level and continues in the emergency department, hospital setting, and after ...
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#1Laura Houard (UCL: Université catholique de Louvain)H-Index: 4
#2Marie-Bénédicte Benaets (UCL: Université catholique de Louvain)H-Index: 1
Last. Bernhard Gerber (UCL: Université catholique de Louvain)H-Index: 61
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Abstract Objectives This study sought to compare the prognostic value of 2-dimensional (2D) right ventricular (RV) speckle tracking (STE) against cardiac magnetic resonance (CMR) RV ejection fraction (EF) and feature tracking (FT) and conventional echocardiographic parameters on overall and cardiovascular (CV) survival in patients with heart failure with reduced EF (HFrEF). Background Prior works showed that RV systolic function predicts prognosis in HFrEF. 2D RVSTE had recently been proposed as...
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#2Brandon M. Wiley (Mayo Clinic)H-Index: 14
Last. Kianoush Kashani (Mayo Clinic)H-Index: 43
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Main objectives Echocardiographic parameters have been used to predict outcomes for specific intensive care unit (ICU) populations. We sought to define echocardiographic parameters for ICU patients receiving continuous renal replacement therapy (CRRT). Design, setting, participants, and measurements This is a historical cohort study of consecutive ICU patients at Mayo Clinic (Rochester, Minnesota) who received CRRT from December 9, 2006, through November 13, 2015. Only patients with an echocardi...
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#1Soo Jin Na (SMC: Samsung Medical Center)H-Index: 9
#2Chi Ryang Chung (SMC: Samsung Medical Center)H-Index: 23
Last. Jeong Hoon YangH-Index: 30
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Resumen Introduccion y objetivos Este estudio investigo si la escala de vasoactivos inotropicos (VIS) es un predictor independientemente de la mortalidad en el shock cardiogenico (SC). Metodos Estudio observacional retrospectivo. Se estudio a los pacientes que ingresaron entre enero de 2012 y diciembre de 2015 en la unidad de cuidados intensivos cardiacos, y finalmente se incluyo a 493 pacientes con SC. Para cuantificar el apoyo farmacologico, se dividio a los pacientes en quintiles de VIS: 1-10...
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#1Saraschandra Vallabhajosyula (Mayo Clinic)H-Index: 25
#2Jacob C. Jentzer (Mayo Clinic)H-Index: 25
Last. Vivek N. Iyer (Mayo Clinic)H-Index: 20
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Background Vasoactive medications are essential in septic shock, but are not fully incorporated into current mortality prediction risk scores. We sought to develop a novel mortality prediction model for septic shock incorporating quantitative vasoactive medication usage.
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#1Jacob C. Jentzer (Mayo Clinic)H-Index: 25
#2Dennis H. Murphree (Mayo Clinic)H-Index: 13
Last. Gregory W. Barsness (Mayo Clinic)H-Index: 41
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Older adults account for an increasing number of cardiac intensive care unit (CICU) admissions. This study sought to determine the predictive value of illness severity scores for mortality in CICU patients ≥70 years of age. Adult patients admitted to the CICU from 2007 to 2015 at one tertiary care hospital were reviewed. Severity of illness scores were calculated on the first CICU day. Area under the receiver-operator characteristic curve (AUROC) values were used to assess discrimination for hos...
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Abstract Background Acute kidney injury is the most frequent complication in patients with septic shock and is an independent risk factor for death. Although renal-replacement therapy is the standa...
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#1Shweta BansalH-Index: 11
#2Anand Prasad (University of Texas at Austin)H-Index: 25
Last. Stuart L. Linas (University of Colorado Denver)H-Index: 43
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The cardiorenal syndromes (CRSs) are defined as disorders of the heart and kidneys, whereby acute or chronic dysfunction of one organ induces acute or chronic dysfunction of the other.[1][1] Generally, CRSs are classified into five subtypes, which are conceptual and largely on the basis of expert
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Cited By6
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Background The neutrophil percentage-to-albumin ratio (NPAR) is a systemic inflammation-based predictor associated with many diseases' outcomes. Nevertheless, there are few studies on the relationship between NPAR and inflammatory markers, and more importantly, the prognostic value of NPAR in critically ill patients with cardiovascular disease (CVD) remains unknown. Methods The data of this retrospective cohort study were from the Medical Information Mart data for Intensive Care III database (MI...
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#1P. Elliott Miller (Yale University)H-Index: 15
#2Alexander Thomas (Yale University)H-Index: 2
Last. Jacob C. Jentzer (Mayo Clinic)H-Index: 25
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BACKGROUND Current cardiac intensive care unit (CICU) practice has seen an increase in patient complexity, including an increase in noncardiac organ failure, critical care therapies, and comorbidities. We sought to describe the changing epidemiology of noncardiac multimorbidity in the CICU population. METHODS We analyzed consecutive unique patient admissions to 2 geographically distant tertiary care CICUs (n = 16,390). We assessed for the prevalence of 0, 1, 2, and ≥3 noncardiac comorbidities (d...
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#1Mitchell Padkins (Mayo Clinic)H-Index: 1
#2Thomas J. Breen (Mayo Clinic)H-Index: 4
Last. Jacob C. Jentzer (Mayo Clinic)H-Index: 25
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BACKGROUND Acute kidney injury (AKI) is common among patients with cardiogenic shock (CS) and it is independently associated with mortality. We sought to assess the prevalence, severity, and prognosis of AKI as a function of cardiogenic shock severity in unselected Cardiac Intensive Care Unit (CICU) patients. METHODS We retrospectively reviewed admissions to the Mayo Clinic between 2007 to 2015 and stratified patients by the AKI stage (based on modified Kidney Disease: Improving Global Outcomes ...
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Continuous renal replacement therapy (CRRT) is a broadly-accepted treatment for critically ill patients with acute kidney injury to optimize fluid and electrolyte management. Despite intensive dialysis care, there is a high mortality rate among these patients. There is uncertainty regarding the factors associated with in-hospital mortality among patients requiring CRRT. This review evaluates how various risk factors influence the in-hospital mortality of critically ill patients who require CRRT....
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#1Jacob C. Jentzer (Mayo Clinic)H-Index: 25
#2Azra Bihorac (UF: University of Florida)H-Index: 49
Last. Michael A. SolomonH-Index: 24
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Acute kidney injury (AKI) and cardiorenal syndrome (CRS) are increasingly prevalent in hospitalized patients with cardiovascular disease and remain associated with poor short- and long-term outcomes. There are no specific therapies to reduce mortality related to either AKI or CRS, apart from supportive care and volume status management. Acute renal replacement therapies (RRTs), including ultrafiltration, intermittent hemodialysis, and continuous RRT are used to manage complications of medically ...
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#1Jacob C. Jentzer (Mayo Clinic)H-Index: 25
#2Thomas J. Breen (Mayo Clinic)H-Index: 4
Last. Kianoush Kashani (Mayo Clinic)H-Index: 43
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Abstract Purpose To describe the epidemiology and outcomes of acute kidney injury (AKI) among contemporary non-surgical cardiac intensive care unit (CICU) patients. Materials and methods We reviewed adult non-surgical CICU patients admitted from 2007 to 2015. The highest AKI stage during hospitalization was defined using modified Kidney Disease: Improving Global Outcomes (KDIGO) criteria, based on changes in serum creatinine. Hospital and 5-year mortality were examined using logistic regression ...
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