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Outcomes of Septic Patients Requiring New Onset Renal Replacement Therapy - A Single Center Retrospective Analysis
Description
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A1875 - Outcomes of Septic Patients Requiring New Onset Renal Replacement Therapy - A Single Center Retrospective Analysis
Author Block: J. R. Woytanowski1, C. Rincon-Prieto2, M. Stephen3; 1Internal Medicine, Drexel University College of Medicine, Philadelphia, PA, United States, 2Pulmonary and Critical Care, Drexel University College of Medicine, Philadelphia, PA, United States, 3Pulmonary and Critical Care, Drexel University, Philadelphia, PA, United States.
Introduction
Acute kidney injury (AKI), as defined by an increase of serum creatinine of at least 1.5-1.9 times the baseline or an increase of at least 0.3 mg/dL from baseline, occurs frequently among critically ill patients, with a prevalence of approximately 40-57%. Due to advancements in treatment strategies, renal replacement therapy (RRT) is becoming a common element of the intensive care setting; about 13% of patients with AKI in the intensive care unit receive RRT during their treatment course. Several studies have demonstrated that AKI in critically ill patients is associated with high mortality rates (some report as high as 80%), as well as other complications including development of end stage renal disease (ESRD) requiring long term dialysis, regardless of causative pathologies. We sought to explore outcomes specifically of patients with sepsis/septic shock with AKI requiring new renal replacement therapy in our inner city university hospital.
Methods
A retrospective chart analysis was performed of all patients with a diagnosis of sepsis and/or septic shock who were treated with at least one form of RRT during the time period of 6/2016 – 5/2017 at Hahnemann University Hospital in Philadelphia, PA. We included all adults (at least 18 yrs of age) who required new onset RRT. Exclusion criteria included any patient with known ESRD having received RRT previously and those with other reasons for renal injury other than sepsis. A total of 25 patients were included in the study. We examined multiple data points including demographics, type of RRT, acute physiology and chronic health evaluation II (APACHE II) and sequential organ failure assessment (SOFA) scores. The outcomes we observed for included length of RRT, length of hospital stay, renal recovery and 5, 30, 60 and 90-day mortality rates.
Results
84% (21/25) of patients received continuous RRT only, while 16% (4/25) received both continuous and intermittent dialysis. Overall survival rate among all included patients was 16%. 30-day mortality rate was 64%, 60 day mortality rate was 76% and total 90 day mortality rate was 84%. Of the surviving patients, 75% had renal recovery with only 1 patient requiring long term dialysis.
Conclusion
Sepsis and septic shock with AKI requiring new RRT is associated with significant mortality rates. Our results coincide with the current paradigm that AKI requiring RRT in critically ill patients is a poor prognostic indicator associated with dismal outcomes. Renal recovery is possible in surviving patients.
Author Block: J. R. Woytanowski1, C. Rincon-Prieto2, M. Stephen3; 1Internal Medicine, Drexel University College of Medicine, Philadelphia, PA, United States, 2Pulmonary and Critical Care, Drexel University College of Medicine, Philadelphia, PA, United States, 3Pulmonary and Critical Care, Drexel University, Philadelphia, PA, United States.
Introduction
Acute kidney injury (AKI), as defined by an increase of serum creatinine of at least 1.5-1.9 times the baseline or an increase of at least 0.3 mg/dL from baseline, occurs frequently among critically ill patients, with a prevalence of approximately 40-57%. Due to advancements in treatment strategies, renal replacement therapy (RRT) is becoming a common element of the intensive care setting; about 13% of patients with AKI in the intensive care unit receive RRT during their treatment course. Several studies have demonstrated that AKI in critically ill patients is associated with high mortality rates (some report as high as 80%), as well as other complications including development of end stage renal disease (ESRD) requiring long term dialysis, regardless of causative pathologies. We sought to explore outcomes specifically of patients with sepsis/septic shock with AKI requiring new renal replacement therapy in our inner city university hospital.
Methods
A retrospective chart analysis was performed of all patients with a diagnosis of sepsis and/or septic shock who were treated with at least one form of RRT during the time period of 6/2016 – 5/2017 at Hahnemann University Hospital in Philadelphia, PA. We included all adults (at least 18 yrs of age) who required new onset RRT. Exclusion criteria included any patient with known ESRD having received RRT previously and those with other reasons for renal injury other than sepsis. A total of 25 patients were included in the study. We examined multiple data points including demographics, type of RRT, acute physiology and chronic health evaluation II (APACHE II) and sequential organ failure assessment (SOFA) scores. The outcomes we observed for included length of RRT, length of hospital stay, renal recovery and 5, 30, 60 and 90-day mortality rates.
Results
84% (21/25) of patients received continuous RRT only, while 16% (4/25) received both continuous and intermittent dialysis. Overall survival rate among all included patients was 16%. 30-day mortality rate was 64%, 60 day mortality rate was 76% and total 90 day mortality rate was 84%. Of the surviving patients, 75% had renal recovery with only 1 patient requiring long term dialysis.
Conclusion
Sepsis and septic shock with AKI requiring new RRT is associated with significant mortality rates. Our results coincide with the current paradigm that AKI requiring RRT in critically ill patients is a poor prognostic indicator associated with dismal outcomes. Renal recovery is possible in surviving patients.
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