Abstract: TH-OR120
Impact of Echocardiographic Parameters on Mortality in ICU Patients Undergoing CRRT
Session Information
- Predicting AKI and Clinical Outcomes
October 25, 2018 | Location: 1B, San Diego Convention Center
Abstract Time: 06:18 PM - 06:30 PM
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
Authors
- Kompotiatis, Panagiotis, Mayo Clinic, Rochester, Minnesota, United States
- Wiley, Brandon M., Mayo Clinic, Rochester, Minnesota, United States
- Jentzer, Jacob, Mayo Clinic, Rochester, Minnesota, United States
- Kashani, Kianoush, Mayo Clinic, Rochester, Minnesota, United States
Background
Echocardiographic abnormalities have been associated with adverse outcomes in various Intensive care unit (ICU) populations. However, the impact of echocardiographic abnormalities on the prediction of mortality in patients undergoing continuous renal replacement therapy (CRRT) has not been examined.
Methods
Historical cohort study of consecutive adults admitted to the ICUs at one tertiary care hospital from December 2006, through November 2015 who underwent CRRT and had an echocardiogram done within 7 days of CRRT initiation. The primary outcome was 30-day death rate. Logistic regression was used to determine predictors of 30-day mortality.
Results
We included 1,276 patients, 1,040 (81.5%) with acute kidney injury (AKI) and 236 (18.5%) with end-stage renal disease (ESRD). Median patient age was 63 (IQR 53-73) years, and 514 (40%) were female, median Charlson score was 5 (IQR 3-7), and median SOFA score on the day of CRRT initiation was 12 (IQR 10-14). Echocardiographic parameters associated with 30-day mortality on univariate analysis included: Moderate or greater right ventricular (RV) dysfunction (OR 1.47, 95% CI: 1.08-1.60), moderate or greater tricuspid regurgitation (OR 1.67, 95% CI: 1.26 – 2.21) and right ventricular systolic pressure (RVSP) (OR 1.12 per 10 mmHg increase, 95% CI: 1.02-1.23). RV dysfunction (OR 1.54, 95% CI: 1.02-2.32) and tricuspid regurgitation (OR 1.55, 95% CI:1.02-2.32) remained significantly associated with 30-day mortality after adjusting for age, sex, SOFA score, Charlson comorbidity index, need for mechanical ventilation, type of ICU, fluid balance and AKI vs. ESRD using logistic regression analysis.
Conclusion
RV dysfunction and tricuspid regurgitation are associated with increased mortality in patients undergoing CRRT, emphasizing the importance of cardiorenal syndrome among critically-ill patients. Further study will be needed to determine if RV dysfunction is a risk marker or a modifiable risk factor in this patient population.