Dataset Information

Effect of diuretic use on 30-day postdialysis mortality in critically ill patients receiving acute dialysis.

ABSTRACT:

Background

The impact of diuretic usage and dosage on the mortality of critically ill patients with acute kidney injury is still unclear.

Methods and results

In this prospective, multicenter, observational study, 572 patients with postsurgical acute kidney injury receiving hemodialysis were recruited and followed daily. Thirty-day postdialysis mortality was analyzed using Cox's proportional hazards model with time-dependent covariates. The mean age of the 572 patients was 60.8±16.6 years. Patients with lower serum creatinine (p?=?0.031) and blood lactate (p?=?0.033) at ICU admission, lower predialysis urine output (p?=?0.001) and PaO(2)/FiO(2) (p?=?0.039), as well as diabetes (p?=?0.037) and heart failure (p?=?0.049) were more likely to receive diuretics. A total of 280 (49.0%) patients died within 30 days after acute dialysis initiation. The analysis of 30-day postdialysis mortality by fitting propensity score-adjusted Cox's proportional hazards models with time-dependent covariates showed that higher 3-day accumulated diuretic doses after dialysis initiation (HR?=?1.449, p?=?0.021) could increase the hazard rate of death. Moreover, higher time-varying 3-day accumulative diuretic doses were associated with hypotension (p<0.001) and less intense hemodialysis (p<0.001) during the acute dialysis period.

Background and significance

Higher time-varying 3-day accumulative diuretic dose predicts mortality in postsurgical critically ill patients requiring acute dialysis. Higher diuretic doses are associated with hypotension and a lower intensity of dialysis. Caution should be employed before loop diuretics are administered to postsurgical patients during the acute dialysis period.

SUBMITTER: Wu VC

PROVIDER: S-EPMC3303770 | biostudies-literature | 2012

REPOSITORIES: biostudies-literature

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Publications

Effect of diuretic use on 30-day postdialysis mortality in critically ill patients receiving acute dialysis.

Wu Vin-Cent VC Lai Chun-Fu CF Shiao Chih-Chung CC Lin Yu-Feng YF Wu Pei-Chen PC Chao Chia-Ter CT Hu Fu-Chang FC Huang Tao-Min TM Yeh Yu-Chang YC Tsai I-Jung IJ Kao Tze-Wah TW Han Yin-Yi YY Wu Wen-Chung WC Hou Chun-Cheng CC Young Guang-Huar GH Ko Wen-Je WJ Tsai Tun-Jun TJ Wu Kwan-Dun KD

PloS one 20120314 3

<h4>Background</h4>The impact of diuretic usage and dosage on the mortality of critically ill patients with acute kidney injury is still unclear.<h4>Methods and results</h4>In this prospective, multicenter, observational study, 572 patients with postsurgical acute kidney injury receiving hemodialysis were recruited and followed daily. Thirty-day postdialysis mortality was analyzed using Cox's proportional hazards model with time-dependent covariates. The mean age of the 572 patients was 60.8±16. ...[more]

PMID: 22431960

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Project description:OBJECTIVES:To identify characteristics that predict 30-day mortality among patients critically ill with coronavirus disease 2019 in England, Wales, and Northern Ireland. DESIGN:Observational cohort study. SETTING:A total of 258 adult critical care units. PATIENTS:A total of 10,362 patients with confirmed coronavirus disease 2019 with a start of critical care between March 1, 2020, and June 22, 2020, of whom 9,990 were eligible (excluding patients with a duration of critical care less than 24 hr or missing core variables). MEASUREMENTS AND MAIN RESULTS:The main outcome measure was time to death within 30 days of the start of critical care. Of 9,990 eligible patients (median age 60 yr, 70% male), 6,027 died within 30 days of the start of critical care. As of July 22, 2020, 189 patients were still receiving critical care and a further 446 were still in acute hospital. Data were missing for between 0.1% and 7.2% of patients across prognostic factors. We imputed missing data ten-fold, using fully conditional specification and continuous variables were modeled using restricted cubic splines. Associations between the candidate prognostic factors and time to death within 30 days of the start of critical care were determined after adjustment for multiple variables with Cox proportional hazards modeling. Significant associations were identified for age, ethnicity, deprivation, body mass index, prior dependency, immunocompromise, lowest systolic blood pressure, highest heart rate, highest respiratory rate, PaO2/FIO2 ratio (and interaction with mechanical ventilation), highest blood lactate concentration, highest serum urea, and lowest platelet count over the first 24 hours of critical care. Nonsignificant associations were found for sex, sedation, highest temperature, and lowest hemoglobin concentration. CONCLUSIONS:We identified patient characteristics that predict an increased likelihood of death within 30 days of the start of critical care for patients with coronavirus disease 2019. These findings may support development of a prediction model for benchmarking critical care providers.

Project description:BackgroundThirty-day hospital readmissions are common among maintenance dialysis patients. Prior studies have evaluated easily measurable readmission risk factors such as comorbid conditions, laboratory results, and hospital discharge day. We undertook this prospective study to investigate the associations between hospital-assessed depression, health literacy, social support, and self-rated health (separately) and 30-day hospital readmission among dialysis patients.MethodsParticipants were recruited from the University of North Carolina Hospitals, 2014-2016. Validated depression, health literacy, social support, and self-rated health screening instruments were administered during index hospitalizations. Multivariable logistic regression models with 30-day readmission as the dependent outcome were used to examine readmission risk factors.ResultsOf the 154 participants, 58 (37.7%) had a 30-day hospital readmission. In unadjusted analyses, individuals with positive screening for depression, lower health literacy, and poorer social support were more likely to have a 30-day readmission (vs. negative screening). Positive depression screening and poorer social support remained significantly associated with 30-day readmission in models adjusted for race, heart failure, admitting service, weekend discharge day, and serum albumin: adjusted OR (95% CI) 2.33 (1.02-5.15) for positive depressive symptoms and 2.57 (1.10-5.91) for poorer social support. The area under the receiver operating characteristic curve (AUC) of the multivariable model adjusted for social support status was significantly greater than the AUC of the multivariable model without social support status (test for equality; p value = 0.04).ConclusionPoor social support and depressive symptoms identified during hospitalizations may represent targetable readmission risk factors among dialysis patients. Our findings suggest that hospital-based assessments of select psychosocial factors may improve readmission risk prediction.

Dataset Information

Effect of diuretic use on 30-day postdialysis mortality in critically ill patients receiving acute dialysis.

Background

Methods and results

Background and significance

Publications

Effect of diuretic use on 30-day postdialysis mortality in critically ill patients receiving acute dialysis.

Similar Datasets

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