Xiayin Li1,2, Ming Bai2, Yan Yu2, Feng Ma2, Lijuan Zhao2, Yajuan Li2, Hao Wu2, Lei Zhou3, Shiren Sun2. 1. Department of Postgraduate Student, Xi'an Medical University, Xi'an, China. 2. The Nephrology Department of Xijing Hospital, The Fourth Military Medical University, Xi'an, China. 3. The Clinical Laboratory Department of Xijing Hospital, The Fourth Military Medical University, Xi'an, China.
Abstract
BACKGROUND: Continuous renal replacement therapy (CRRT) is commonly employed for rhabdomyolysis (RM) patients. However, the optimal initiation timing of CRRT and prognostic factors were not well evaluated for patients with RM. We aimed to investigate the efficacy of CRRT timing on mortality and the risk factors for death in RM patients who received CRRT. METHODS: RM patients who received CRRT between 1 May 2010 and 31 May 2021 in our center were retrospectively included. Univariate and multivariate logistic analyses were performed to identify the risk factors for primary outcome (90-day mortality). RESULTS: A total of 134 patients were included in our study. The 90-day mortality rate was 38.06%. The median time from CRRT initiation to peak CK occurrence was 4.8 h (IQR -16, 14), 67 patients received CRRT before 4.8 h after peak CK occurrence (early CRRT), and 67 patients received CRRT beyond 4.8 h after peak CK occurrence (late CRRT). Multivariate logistic regression analysis showed that the time from CRRT initiation to the peak CK (per 1 h, OR 1.026, 95% CI 1.004-1.049, p = 0.023), late CRRT (OR 3.082, 95% CI 1.072-8.859, p = 0.037), elevated serum cardiac troponin I (cTnI) (per 1 ng/mL, OR 1.218, 95% CI 1.011-1.468, p = 0.038), older age (per 1 year, OR 1.042, 95% CI 1.003-1.081, p = 0.032), and need of mechanical ventilation support (OR 4.632, 95% CI 1.292-16.61, p = 0.019) were independent risk factors for 90-day mortality. CONCLUSIONS: Earlier CRRT initiation before 4.8 h after peak CK occurrence was associated with lower 90-day patient mortality.
BACKGROUND: Continuous renal replacement therapy (CRRT) is commonly employed for rhabdomyolysis (RM) patients. However, the optimal initiation timing of CRRT and prognostic factors were not well evaluated for patients with RM. We aimed to investigate the efficacy of CRRT timing on mortality and the risk factors for death in RM patients who received CRRT. METHODS: RM patients who received CRRT between 1 May 2010 and 31 May 2021 in our center were retrospectively included. Univariate and multivariate logistic analyses were performed to identify the risk factors for primary outcome (90-day mortality). RESULTS: A total of 134 patients were included in our study. The 90-day mortality rate was 38.06%. The median time from CRRT initiation to peak CK occurrence was 4.8 h (IQR -16, 14), 67 patients received CRRT before 4.8 h after peak CK occurrence (early CRRT), and 67 patients received CRRT beyond 4.8 h after peak CK occurrence (late CRRT). Multivariate logistic regression analysis showed that the time from CRRT initiation to the peak CK (per 1 h, OR 1.026, 95% CI 1.004-1.049, p = 0.023), late CRRT (OR 3.082, 95% CI 1.072-8.859, p = 0.037), elevated serum cardiac troponin I (cTnI) (per 1 ng/mL, OR 1.218, 95% CI 1.011-1.468, p = 0.038), older age (per 1 year, OR 1.042, 95% CI 1.003-1.081, p = 0.032), and need of mechanical ventilation support (OR 4.632, 95% CI 1.292-16.61, p = 0.019) were independent risk factors for 90-day mortality. CONCLUSIONS: Earlier CRRT initiation before 4.8 h after peak CK occurrence was associated with lower 90-day patient mortality.
Authors: Alexander Zarbock; John A Kellum; Christoph Schmidt; Hugo Van Aken; Carola Wempe; Hermann Pavenstädt; Andreea Boanta; Joachim Gerß; Melanie Meersch Journal: JAMA Date: 2016 May 24-31 Impact factor: 56.272
Authors: Raghavan Murugan; Samantha J Kerti; Chung-Chou H Chang; Martin Gallagher; Gilles Clermont; Paul M Palevsky; John A Kellum; Rinaldo Bellomo Journal: JAMA Netw Open Date: 2019-06-05