Related factors of the prognosis in patients with first time receiving continuous renal replacement therapy at surgical intensive care unit
Date Issued
2015
Date
2015
Author(s)
Chan, Shih-Yi
Abstract
Background: Acute renal injury/failure was a common complication among patients who admitted to surgical intensive care unit (SICU). The incidence rate was 20% to 67% and mortality rate was 26%. There was a huge medical cost and spending for follow-up health care. The study focused at related factors and prognosis of SICU patients who first-time receiving continuous renal replacement therapy (CRRT). Objective: To understand the incidence and prognosis of acute renal injury/failure; to understand the characteristics of demographic and disease in patients with CRRT; to analyze the relation between clinical situation and prognosis in patients with CRRT; to explore the related factors of prognosis in patients with CRRT. Method: This study was a retrospective and descriptive correlational design in which data were retrieved from medical charts of patients who first-time receiving CRRT at a medical center SICU in central Taiwan. Data was collected from January 1st, 2012 to December 31st, 2013 by using a self-designed chart-record sheet. The data was analyzed by descriptive statistics and inferential statistics. Results: The incidence rate of CRRT was 6.4% and 251cases were recruited. When the subjects discharged from SICU after 1-73days staying, there were 118 survivals and the mortality rate was 53％. Among survivals, becoming hemodialysis-depended patients were 27 (23％) and the others (77%) were free from dialysis therapy. Male, age≧70 years old and gastro-intestinal surgical patients, they had higher risk to acute renal injury/failure. Comparing the two groups (survivals vs. deaths) in the serum creatinine at SICU admitted (3.2 vs. 2.1 mg/dL), the percentage of belonging RIF levels in RIFLE criteria (80% vs. 51%), the interval of SICU admitted to on-CRRT (4.8 vs. 6.7 days), the serum creatinine at pre on-CRRT (3.7 vs. 2.9 mg/dL), the percentage of non-shock (33% vs. 20%), the percentage of non-using mechanical ventilator (15% vs. 5%). The results showed significant differences between the two groups. The abnormal serum creatinine while admitted to SICU, the interval of SICU admitted to on-CRRT ≦2 days and no mechanical ventilator using at pre on-CRRT, they had higher survival rate. Conclusion: The study found that elder male patients and APACHEⅡscore≧20 had higher risk to acute renal injury/failure. Evaluating patients comprehensively and implementing CRRT at the right moment were important in clinical practice, and then allowed survivors have a higher chance of recovering renal function.
Subjects
acute renal injury/failure
continuous renal replacement therapy
Kaplan-Meier survival analysis
Type
thesis
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