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Critical Care |

Prognosis of Critically Ill Medical Intensive Care Unit Patients Treated with Continuous Venovenous Hemodialysis

Nikhil Agrawal, MD; Tanush Gupta, MD; Sahil Agrawal, MD; Jalaj Garg, MD; Dipak Chandy, MD
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New York Medical College, Valhalla, NY


Chest. 2013;144(4_MeetingAbstracts):361A. doi:10.1378/chest.1701604
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Abstract

SESSION TITLE: Critical Care Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PM

PURPOSE: Continuous Veno-Venous Hemodialysis (CVVHD) is preferred to conventional intermittent hemodialysis as renal replacement therapy in hemodynamically unstable patients. The aim of our study was to examine the outcome and determinants of mortality in patients treated with CVVHD in a Medical Intensive Care Unit (MICU)

METHODS: Retrospective chart review of 60 consecutive patients ≥18 years of age treated with CVVHD in an 11-bed MICU of a university hospital.

RESULTS: Mean age of our study population was 60.7 ± 13.7 years with 39 males and 21 females. The mean APACHE II score at ICU admission was 23.6 ± 6.6. The 7-day mortality was 28.3% (17/60), 30 day mortality was 65% (39/60), while the total in-hospital mortality was 71.7% (43/60). The average duration of CVVHD was 7.3 ± 5.8 days. 26 patients (43.3%) had liver cirrhosis with in-hospital mortality of 76.9%, 13(21.6%) had active oncologic disease with mortality of 92.3%, while 21 (31.1%) with a variety of other diagnoses had 52.3% mortality. The mortality in patients with cirrhosis or active oncologic disease was significantly higher than in patients with other diagnoses (p=0.03). We found no significant difference in overall mortality between elderly (≥65 years), and non-elderly (<65 years) subjects (17/26 (65.3%) vs. 26/34(76.4%), p=0.39). Duration of CVVHD and number of vasopressors at the time of initiation of CVVHD were not statistically significant for higher in-hospital mortality (OR 1.02, p = 0.66 and OR 1.93, p = 0.06 respectively).

CONCLUSIONS: Mortality in MICU patients treated with CVVHD is high and significantly higher in patients with cirrhosis or active oncologic disease. In our patients, older age, higher pressor requirement or longer duration of CVVHD were not significant predictors of in-hospital mortality.

CLINICAL IMPLICATIONS: The high overall mortality should be considered and communicated while initiating CVVHD in patients admitted to an MICU. Patients with cirrhosis or active oncologic disease on CVVHD have a much worse prognosis than patients with other diagnoses while advanced age does not appear to contribute to overall mortality.

DISCLOSURE: The following authors have nothing to disclose: Nikhil Agrawal, Tanush Gupta, Sahil Agrawal, Jalaj Garg, Dipak Chandy

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