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- OpenAccess
Predictive Factors in Positive Outcome for Continuous Renal Replacement Therapy
並列摘要
Objective: The purpose of this study was to determine what factors may predict positive outcomes in continuous renal replacement therapy (CRRT). Design: This study used a retrospective study design to measure and compare the demographic data and clinical parameters of patients who eventually could be weaned from CRRT and those who could not be. Setting: The medical intensive care units (MICU) of a university teaching hospital. Patients: A total of fifty-six patients, who received CRRT (both continuous veno-venous hemofiltration and continuous veno-venous hemodialysis) during the periods of April 1998 to September 1999, were enrolled. Among them, nineteen was successfully weaned from CRRT and thirty-seven were not. Methods: The patients were divided into two ”weaned” and ”not-weaned” groups based on whether or not they could be weaned from CRRT. The demographic data and clinical parameters of these two groups of patients were collected and compared. We also examined the possible relationship between different pre-CRRT and steady-state blood urea nitrogen (BUN) levels and successful CRRT weaning. Results: Regarding the demographic data, the patients in the ”weaned” group had a lesser duration of CRRT, lesser need of mechanical ventilators and inotropic agents, and higher mean blood pressure than those in the ”not-weaned” group. Further, the patients in the ”weaned” group showed better outcomes in terms of the patients' survival in the hospital (with lower hospital mortality and lower ICU mortality). Concerning clinical parameters, the biochemical results before and after CRRT between these two groups were similar, except for the higher platelet counts before CRRT, and lesser prolonged prothrombin time after CRRT, in the ”weaned” group. The APACHE Ⅱ scores between these two groups were similar at the time of admission to ICU. However, the organ failure scores at the onset of CRRT were higher in the patients who subsequently failed to be weaned from CRRT (3.8±0.8 vs. 2.9±1.2). We also found there was significantly higher ICU mortality if pre-CRRT BUN levels were higher than 60 mg/dl. Moreover there was significantly higher ICU mortality when steady-state BUN levels were higher than 60 mg/dl. Conclusion: We found that the outcome was better for the CRRT patients with lower organ failure scores at the onset of CRRT; the patients with higher platelet counts before CRRT had a better chance of being weaned from CRRT; and the higher the pre-CRRT BUN levels, the poorer the final outcome. These results suggest that the early start of CRRT in the patients with lower BUN levels and lower organ failure scores might produce better outcomes. Finally, there was significantly high ICU mortality among the patients whose steady-state BUN level was higher than 60 mg/dl. Therefore, we should try to maintain steady-state BUN levels at less than 60 mg/dl.
延伸閱讀
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