Epidemiology and prognostic factors of critically ill patients treated with hemodiafiltration |
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| Authors: | Soubrier Stéphane Leroy Olivier Devos Patrick Nseir Saad Georges Hugues d'Escrivan Thibaud Guery Benoit |
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| Institution: | 1. Division of Pulmonary & Critical Care Medicine, University of Maryland School of Medicine, Baltimore, MD, USA;2. Institute for Global Health, University of Maryland School of Medicine, Baltimore, MD, USA;3. Department of Medicine, St Luke Family Hospital, Port-au-Prince, Haiti;4. Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA;5. Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA;6. Division of Pulmonary & Critical Care Medicine, University of Washington School of Medicine, Seattle, WA, USA;7. International Respiratory and Severe Illness Center, University of Washington School of Medicine, Seattle, WA, USA;1. Department of Medicine, Jackson Memorial Hospital, 1611 NW12th Avenue, Miami, FL, 33136;2. Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, 1120 NW 14th Street, Miami, FL, 33136;3. Department of Pathology and Microbiology, University of Miami Miller School of Medicine, 1611 NW 12th Avenue, Miami, FL, 33136;4. Department of Infection Control and Antimicrobial Stewardship, Jackson Health System, 1611 NW 12th Avenue, Miami, FL, 33136 |
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| Abstract: | PURPOSE: The objective of this study is to study the epidemiology, outcome, and prognostic factors of critically ill patients treated with continuous venovenous hemodiafiltration (CVVHDF). MATERIALS AND METHODS: Observational cohort was done in a French 16-bed intensive care unit (ICU) from a university-affiliated urban hospital. All patients requiring, in the opinion of the treating physician, the initiation of CVVHDF were included in the study. RESULTS: One hundred ninety-seven patients with acute renal failure (ARF) treated with CVVHDF were studied. The incidence of ARF treated with CVVHDF was 5.9% in the ICU with a mortality rate of 71.6%. A multivariate analysis identified 3 independent factors associated with fatal outcome: mechanical ventilation, sepsis, and septic shock requiring vasoactive drug. In contrast, 2 independent factors predicted a favorable outcome: nonoliguric ARF and serum creatinine concentration higher than 34 mg/L at CVVHDF initiation. A flowchart determined by the chi2 Automatic Interaction and Detection statistical method allowed for the identification of patients' subgroups with different mortality rates ranging from 25% to 100%. CONCLUSIONS: In our series, ARF treated with CVVHDF was associated with a high overall ICU mortality rate (71.6%). However, our prognostic flowchart identified patients with low mortality rates for which renal replacement therapy must be initiated with no discussion as soon as required. |
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| Keywords: | Epidemiology Prognostic factors Hemodiafiltration |
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