Kevin M Lowe1, Alan C Heffner2, Colleen H Karvetski3. 1. Center for Advanced Practice, Medical Critical Care Fellowship, Carolinas Healthcare System, Charlotte, North Carolina. 2. Department of Emergency Medicine, Carolinas Medical Center, Charlotte, North Carolina; Department of Internal Medicine, Division of Critical Care, Carolinas Medical Center, Charlotte, North Carolina. 3. Information and Analytics Services, Carolinas Healthcare System, Charlotte, North Carolina.
Abstract
BACKGROUND: Infection is the second leading cause of death in end-stage renal disease (ESRD) patients. Prior investigations of acute septic shock in this specific population are limited. OBJECTIVE: We aimed to evaluate the clinical presentation and factors associated with outcome among ESRD patients with acute septic shock. METHODS: We reviewed patients prospectively enrolled in an emergency department (ED) septic shock treatment pathway registry between January 2014 and May 2016. Clinical and treatment variables for ESRD patients were compared with non-ESRD patients. A second analysis focused on ESRD septic shock survivors and nonsurvivors. RESULTS: Among 4126 registry enrollees, 3564 (86.4%) met inclusion for the study. End-stage renal disease was present in 3.8% (n = 137) of ED septic shock patients. Hospital mortality was 20.4% and 17.1% for the ESRD and non-ESRD septic shock patient groups (p = 0.31). Septic shock patients with ESRD had a higher burden of chronic illness, but similar admission clinical profiles to non-ESRD patients. End-stage renal disease status was independently associated with lower fluid resuscitation dose, even when controlling for severity of illness. Age and admission lactate were independently associated with mortality in ESRD septic shock patients. CONCLUSION: ESRD patients comprise a small but important portion of patients with ED septic shock. Although presentation clinical profiles are similar to patients without ESRD, ESRD status is independently associated with lower fluid dose and compliance with the 30-mL/kg fluid goal. Hyperlactatemia is a marker of mortality in ESRD septic shock.
BACKGROUND: Infection is the second leading cause of death in end-stage renal disease (ESRD) patients. Prior investigations of acute septic shock in this specific population are limited. OBJECTIVE: We aimed to evaluate the clinical presentation and factors associated with outcome among ESRDpatients with acute septic shock. METHODS: We reviewed patients prospectively enrolled in an emergency department (ED) septic shock treatment pathway registry between January 2014 and May 2016. Clinical and treatment variables for ESRDpatients were compared with non-ESRDpatients. A second analysis focused on ESRD septic shock survivors and nonsurvivors. RESULTS: Among 4126 registry enrollees, 3564 (86.4%) met inclusion for the study. End-stage renal disease was present in 3.8% (n = 137) of ED septic shockpatients. Hospital mortality was 20.4% and 17.1% for the ESRD and non-ESRD septic shockpatient groups (p = 0.31). Septic shockpatients with ESRD had a higher burden of chronic illness, but similar admission clinical profiles to non-ESRDpatients. End-stage renal disease status was independently associated with lower fluid resuscitation dose, even when controlling for severity of illness. Age and admission lactate were independently associated with mortality in ESRD septic shockpatients. CONCLUSION:ESRDpatients comprise a small but important portion of patients with ED septic shock. Although presentation clinical profiles are similar to patients without ESRD, ESRD status is independently associated with lower fluid dose and compliance with the 30-mL/kg fluid goal. Hyperlactatemia is a marker of mortality in ESRD septic shock.
Authors: Chun Chieh Chu; Chih Min Su; Fu Cheng Chen; Chi Yung Cheng; Hsien Hung Cheng; Chia Te Kung Journal: Medicine (Baltimore) Date: 2021-02-19 Impact factor: 1.817