CLINICAL OUTCOMES IN PATIENTS WITH END-STAGE RENAL DISEASE (ESRD) ADMITTED TO THE MEDICAL ICU (MICU)

Abstract

SESSION TITLE: Critical Care 2 SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/10/2018 01:00 PM - 02:00 PM PURPOSE: Admission rates and outcomes of patients with ESRD on hemodialysis (HD) admitted to the MICU are not well defined in the United States. Although patients with known ESRD are commonly admitted with respiratory failure or sepsis, there is a paucity of data about their demographics and outcomes. Few studies have assessed the validity of predictive scoring models, such as Simplified Acute Physiology Score (SAPS) II and Sequential Organ Failure Assessment (SOFA) score in patients with ESRD admitted to the MICU. The purpose of our investigation was to evaluate factors affecting the outcome and assess the performance of SAPS-II and SOFA scores to predict mortality for patients with ESRD admitted to the MICU. METHODS: Retrospective chart review was performed on 113 patients who were admitted to the MICU at a tertiary care center in an urban area with ESRD over a six-month period. Basic demographic data, diagnoses and comorbid conditions were recorded. Outcome variables included MICU length of stay, MICU mortality and readmission rates. SOFA and SAPS-II scores were used to assess severity of illness. Statistical analysis was performed using GraphPad Prism version 7.0. Student t-test was used for continuous variables; χ2 test and the Fishers Exact test were used for categorical variables. P<0.05 was considered statistically significant. RESULTS: The mean age of patients was 64.8 (±16.2) of which 55.8% were male. The most common indications for admission were respiratory failure (32.7%), sepsis (16.8%) and hyperkalemia (15.0%). Of the patients admitted with respiratory failure, 48.6% presented with flash pulmonary edema. MICU mortality was 17.7%, in-hospital mortality was 21.2%, ICU readmission rate was 5.3% and 30-day readmission was 27.4%. Average MICU length of stay (LOS) was 3.91 days, mean SOFA score (6.63±2.28), mean SAPS-II score (50.5±18.3), mechanical ventilation (36.3%), vasopressor support (4.4%) was observed. By comparison, the general MICU population LOS and mortality during this time period was 3.4 days and 14.7%, respectively. Higher SAPS-II and SOFA scores were associated with mortality in the ICU (p<0.01). Presence of mechanical ventilation (MV) was also associated with higher ICU mortality. CONCLUSIONS: The most common indication for MICU admission in ESRD patients was respiratory failure with approximately half presenting with flash pulmonary edema. Outcomes of ESRD patients on HD in the MICU is poor, especially if they require additional organ support, such as MV. SAPS-II and SOFA scores are useful predictive models for MICU mortality in these patients. Routine use of these indices in this patient population could identify individuals at risk for increased mortality. CLINICAL IMPLICATIONS: ESRD patients admitted to the MICU have a longer LOS and higher mortality than the general population. In this patient population, a higher severity illness score is associated with mortality. DISCLOSURES: No relevant relationships by Abhinav Agrawal, source=Web Response No relevant relationships by Soumya Ashok, source=Admin input No relevant relationships by Zubair Hasan, source=Web Response No relevant relationships by Maksim Korotun, source=Web Response No relevant relationships by Mangala Narasimhan, source=Web Response