Clinical features and outcome of chronic dialysis patients admitted to an intensive care unit (original) (raw)
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Prevalence, incidence and risk factors for acute renal failure in the intensive care unit
Critical Care, 2005
Introduction Community-acquired pneumonia remains a common condition worldwide. It is associated with significant morbidity and mortality. The aim of this study was to evaluate conditions that could predict a poor outcome. Design Retrospective analyse of 69 patients admitted to the ICU from 1996 to 2003. Demographic data included age, sex and medical history. Etiologic agents, multiorgan dysfunction, nosocomial infections, SAPS II and PORT scores were recorded for each patient. For statistical analysis we used a t test, chi-square test and Mann-Whitney U test on SPSS ® . A value of P less than 0.05 was considered significant. Results Forty-seven patients were male and 22 patients were female. Mean age was 52 years. Sixty-seven percent had serious pre-morbid conditions including pulmonary disease (34.8%), cardiac problems (36.2%), diabetes (13%) and chronic liver disease (5.8%); 40.6% were smokers, drug abusers or alcohol dependents. Sixtyeight patients required invasive mechanical ventilation. The average length of ventilation was 13.5 days, median 8 days. The mean SAPS II score was 40.14 and the mean PORT score was 141. The mortality rate was 27.5% (SAPS II estimated mortality, 35%). Complications reported were ARDS (40.6%), septic shock (34.8%), acute renal failure (2.9%), cardiac arrest (8.7%) and nosocomial infeccions (46.4%). Mortality rates were higher for previous hepatic (75%) and metabolic (33%) diseases. We found a close association between crude mortality and SAPS II score (P = 0.003) and development of complications (P = 0.0028). Respiratory dysfunction (P = 0.006) and septic shock (P = 0.022) were most significantly related to mortality. No significant differences were founded regarding age, comorbidities, PORT score, etiologic agents, nosocomial infections and length of invasive mechanical ventilation. Conclusions Previous hepatic chronic disease was strictly related to higher mortality as well as isolation of MRSA. ARDS and septic shock predicted a poor outcome. SAPS II score was the best severity indicator of mortality.
American Journal of Kidney Diseases, 2006
Kidney dysfunction in the intensive care unit (ICU) results in increased morbidity, mortality, and health care costs; however, long-term mortality has not been described across strata of severity in kidney dysfunction. The primary objective is to describe and assess factors associated with 1-year mortality in critically ill patients stratified by severity of kidney dysfunction during admission to the ICU. Kidney dysfunction is defined by peak serum creatinine values and stratified by: (1) no dysfunction (creatinine < 1.7 mg/dL [<150 micromol/L]), (2) mild dysfunction (creatinine, 1.7 to 3.4 mg/dL [150 to 299 micromol/L]), (3) moderate dysfunction (creatinine >or= 3.4 mg/dL [>or= 300 micromol/L]), (4) severe acute dysfunction requiring renal replacement therapy (acute renal failure), or (5) preexisting end-stage kidney disease. Population-based surveillance was of adult residents of the Calgary Health Region (population, 1 million) admitted to any multidisciplinary ICU and a cardiovascular surgery ICU from May 1, 1999, to April 30, 2002. Of 5,693 admissions, 62% were men, median age was 64.9 years (interquartile range, 50.6 to 74.5 years), and mean Acute Physiology and Chronic Health Evaluation (APACHE) II score was 24.9 +/- 8.7 (SD). Case fatality rates stratified by renal dysfunction were 17% (763 of 4,411), 47% (370 of 790), 48% (77 of 160), 64% (153 of 240), and 40% (37 of 92) for no, mild, and moderate dysfunction; severe acute renal failure; and end-stage kidney disease, respectively. By means of multivariate analysis, 1-year mortality was associated independently with advancing age, medical diagnosis, higher APACHE II score, and presence and severity of kidney dysfunction, although no difference was evident comparing those with mild to moderate dysfunction. End-stage kidney disease was not associated independently with 1-year mortality. Severity of kidney dysfunction in patients in the ICU is associated with an incremental increase in long-term mortality. Although patients classified with either mild or moderate kidney dysfunction had an increased risk for death, use of serum creatinine level alone was poor at discriminating long-term outcome, suggesting this measure alone should not be used for defining long-term prognosis.
Outcome of ICU patients requiring dialysis in an African institution
Critical Care, 2009
There is considerable uncertainty about the reproducibility of the various instruments used to measure dyspnea, their ability to reflect changes in symptoms, whether they accurately reflect the patient's experience and if its evolution is similar between acute heart failure syndrome patients and nonacute heart failure syndrome patients. URGENT was a prospective multicenter trial designed to address these issues. Methods Patients were interviewed within 1 hour of first physician evaluation, in the emergency department or acute care setting, with dyspnea assessed by the patient using both a five-point Likert scale and a 10-point visual analog scale (VAS) in the sitting (60º) and then supine (20º) position if dyspnea had not been considered severe or very severe by the sitting versus decubitus dyspnea measurement. Results Very good agreements were found between the five-point Likert and VAS at baseline (0.891, P <0.0001) and between changes (from baseline to hour 6) in the five-point Likert and in VAS (0.800, P <0.0001) in acute heart failure (AHF) patients. Lower agreements were found when changes from baseline to H6 measured by Likert or VAS were compared with the seven-point comparative Likert (0.512 and 0.500 respectively) in AHF patients. The worse the dyspnea at admission, the greater the amplitude of improvement in the first 6 hours; this relationship is stronger when dyspnea is measured with VAS (Spearman's rho coefficient = 0.672) than with the five-point Likert (0.272) (both P <0.0001) in AHF patients. By the five-point Likert, only nine patients (3% (1% to 5%)) reported an improvement in their dyspnea, 177 (51% (46% to 57%)) had no change, and 159 (46% (41% to 52%)) reported worse dyspnea supine compared with sitting up in AHF patients. The PDA test with VAS was markedly different between AHF and non-AHF patients. Conclusions Both clinical tools five-point Likert and VAS showed very good agreement at baseline and between changes from baseline to tests performed 6 hours later in AHF patients. The PDA test with VAS was markedly different between AHF and non-AHF patients. Dyspnea is improved within 6 hours in more than threequarters of the patients regardless of the tool used to measure the change in dyspnea. The greater the dyspnea at admission, the greater the amplitude of improvement in the first 6 hours.
European Journal of Cardio-Thoracic Surgery, 2008
Objective: This study examined the association between hospital mortality and five illness-severity scoring systems evaluated at different time points in the intensive care unit (ICU) as well as clinical variables as predictors in critically ill patients supported by extracorporeal membrane oxygenation (ECMO) and acute dialysis. Methods: This multicenter prospective observational study included 104 patients who received ECMO support and acute dialysis from January 2002 to December 2006. Patients' demographic, clinical and laboratory variables were analyzed as predictors of survival. The SAPS 2, APACHE II, SOFA, MODS, and SAPS 3 scores upon ICU admission and at acute dialysis commencement were evaluated to predict the patient's hospital mortality. Results: Hospital mortality for the study group was 76% (79/104). Among the five scoring systems, only SAPS 3 score showed a significant difference between survivors and non-survivors either upon ICU admission (p = 0.038) or at dialysis commencement (p = 0.001). SAPS 3 score at dialysis commencement showed the best discrimination ability by using the area under the receiver operating characteristic curve (SOFA, 0.55; SAPS 2, 0.56; MODS, 0.58; APACHE II, 0.59; and SAPS 3, 0.73). Multiple logistic regression analysis indicated that SAPS 3 score at dialysis commencement (OR: 1.070, 95% CI: 1.016-1.216) and IABP usage before ECMO (OR: 4.181, 95% CI: 1.448-12.075) were two independent risk factors for hospital mortality. Conclusions: Among five common ICU scoring systems evaluated at different time points, SAPS 3 at dialysis commencement is the best risk adjustment systems to predict hospital mortality in critically ill patients supported by ECMO and acute dialysis. Furthermore, the SAPS 3 score at dialysis commencement and IABP usage before ECMO are two major independent predictors for hospital mortality in patients supported by ECMO and acute dialysis.
HIGH RATES OF MORTALITY AND TECHNIQUE FAILURE IN PERITONEAL DIALYSIS PATIENTS AFTER CRITICAL ILLNESS
Peritoneal Dialysis …, 2011
Introduction: Little is known regarding the causes and outcomes of peritoneal dialysis (PD) patients admitted to the intensive care unit (ICU). We explored the outcomes of technique failure and mortality in a cohort of PD patients admitted to the ICU. ♦ Methods: Using a provincial database of 990 incident PD patients followed from January 1997 to June 2009, we identified 90 (9%) who were admitted to the ICU. Parametric and nonparametric tests were used as appropriate to determine differences in baseline characteristics. The Cox proportional hazards and competing risk methods were used to investigate associations. ♦ Results: Compared with other patients, those admitted to the ICU had been on PD longer (p < 0.0001) and were more often on continuous ambulatory PD (74.2% vs 25.8%, p = 0.016). Cardiac problems were the most common admitting diagnosis (50%), followed by sepsis (23%), with peritonitis accounting for 69% of the sepsis admissions. The 1-year mortality was 53.3%, with 12% alive and converted to hemodialysis, and one third remaining alive on PD. In multivariate Cox modeling, age [hazard ratio (HR): 1.01; 95% confidence interval (CI): 0.99 to 1.03], white blood cell count (HR: 1.02; 95% CI: 1.00 to 1.04), temperature (HR: 0.75; 95% CI: 0.61 to 0.92), and peritonitis (1.64; 95% CI: 1.21 to 2.22) at admission to the ICU were associated with the composite outcome of technique failure or death. In a competing risk analysis, the risk for death was 30%, and for technique failure, 36% at 1 year. ♦ Conclusions: Patients on PD have high rates of death and technique failure after admission to the ICU.
Kidney International, 2002
enough to require dialysis had a mortality of 57%. APACHE Renal failure in the ICU: Comparison of the impact of acute III predicted outcome very well in patients with no renal failure renal failure and end-stage renal disease on ICU outcomes. and patients with ARF at the time of scoring but underpre-Background. Acute renal failure (ARF) is associated with a dicted mortality in those who developed ARF after ICU admispersistent high mortality in critically ill patients in intensive care sion and overestimated mortality in patients with ESRD. units (ICUs). Most studies to date have focused on patients