Edward Clark1, Anand Kumar2, Amit Langote1, Stephen Lapinsky3, Peter Dodek4, Andreas Kramer5, Gordon Wood6, Sean M Bagshaw7, Ken Wood8, Dave Gurka9, Manish M Sood10,11. 1. Department of Medicine, Division of Nephrology, The Ottawa Hospital and Kidney Research Centre, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada. 2. Departments of Medicine, Medical Microbiology and Pharmacology, Section of Critical Care Medicine and Section of Infectious Diseases, University of Manitoba, Winnipeg, MB, Canada. 3. Section of Critical Care Medicine, Mount Sinai Hospital and University of Toronto, Toronto, ON, Canada. 4. Section of Critical Care Medicine, St. Paul's Hospital and University of British Columbia, Vancouver, BC, Canada. 5. Section of Critical Care Medicine, Foothills Hospital and University of Calgary, Calgary, AB, Canada. 6. Section of Critical Care Medicine, Royal Jubilee Hospital/Victoria General Hospital and University of British Columbia, Victoria, BC, Canada. 7. Division of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada. 8. Section of Critical Care Medicine, Geisinger Medical Center, Danville, PA, USA. 9. Section of Critical Care Medicine, Rush Medical College, Chicago, IL, USA. 10. Department of Medicine, Division of Nephrology, The Ottawa Hospital and Kidney Research Centre, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada. msood99@gmail.com. 11. Ottawa Hospital Research Institute, The Ottawa Hospital, Civic campus, 2-014 Administrative Services Building, 1053 Carling Avenue, P.O. Box 693, Ottawa, ON, K1Y 4E9, Canada. msood99@gmail.com.
Abstract
OBJECTIVES: To describe the clinical characteristics and in-hospital mortality of chronic dialysis-dependent end-stage kidney disease patients with septic shock in comparison to septic shock patients not receiving chronic dialysis. METHODS: Using an international, multicenter database, we conducted a retrospective analysis of data collected from 10,414 patients admitted to the intensive care unit (ICU) with septic shock from 1989 to 2013, of which 800 (7.7 %) were chronic dialysis patients. Data on demographic characteristics, sites of infection, microbial pathogens, antimicrobial usage patterns, and in-hospital mortality were aggregated and compared for chronic dialysis and non-dialysis patients. Multivariate time-varying Cox models with and without propensity score matching were constructed to determine the association between dialysis and in-hospital death. RESULTS: Septic shock secondary to central venous catheter infection, peritonitis, ischemic bowel, and cellulitis was more frequent in chronic dialysis patients. The isolation of resistant organisms (10.7 vs. 7.1 %; p = 0.005) and delays in receiving antimicrobials (6.0 vs. 5.0 h) were more common in chronic dialysis patients than in non-dialysis patients. Delayed appropriate antimicrobial therapy was associated with an increased risk of death in chronic dialysis patients (p < 0.0001). In-hospital death occurred in 54.8 and 49.0 % of chronic dialysis and non-dialysis patients, respectively. After propensity score matching, there was no difference in overall survival between chronic dialysis and non-dialysis patients, but survival in chronic dialysis patients decreased over time compared to non-dialysis patients. CONCLUSIONS: The demographic and clinical characteristics of chronic dialysis patients with septic shock differ from those of similar non-dialysis patients. However, there was no significant difference in mortality between the chronic dialysis and non-dialysis patients with septic shock enrolled in this analysis.
OBJECTIVES: To describe the clinical characteristics and in-hospital mortality of chronic dialysis-dependent end-stage kidney diseasepatients with septic shock in comparison to septic shockpatients not receiving chronic dialysis. METHODS: Using an international, multicenter database, we conducted a retrospective analysis of data collected from 10,414 patients admitted to the intensive care unit (ICU) with septic shock from 1989 to 2013, of which 800 (7.7 %) were chronic dialysis patients. Data on demographic characteristics, sites of infection, microbial pathogens, antimicrobial usage patterns, and in-hospital mortality were aggregated and compared for chronic dialysis and non-dialysis patients. Multivariate time-varying Cox models with and without propensity score matching were constructed to determine the association between dialysis and in-hospital death. RESULTS:Septic shock secondary to central venous catheter infection, peritonitis, ischemic bowel, and cellulitis was more frequent in chronic dialysis patients. The isolation of resistant organisms (10.7 vs. 7.1 %; p = 0.005) and delays in receiving antimicrobials (6.0 vs. 5.0 h) were more common in chronic dialysis patients than in non-dialysis patients. Delayed appropriate antimicrobial therapy was associated with an increased risk of death in chronic dialysis patients (p < 0.0001). In-hospital death occurred in 54.8 and 49.0 % of chronic dialysis and non-dialysis patients, respectively. After propensity score matching, there was no difference in overall survival between chronic dialysis and non-dialysis patients, but survival in chronic dialysis patients decreased over time compared to non-dialysis patients. CONCLUSIONS: The demographic and clinical characteristics of chronic dialysis patients with septic shock differ from those of similar non-dialysis patients. However, there was no significant difference in mortality between the chronic dialysis and non-dialysis patients with septic shock enrolled in this analysis.
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