CODE ACUTE KIDNEY INJURY-RENAL REPLACEMENT THERAPY, PROGNOSIS AND SURVIVAL IN PATIENTS WITH ACUTE KIDNEY INJURY AFTER IN-HOSPITAL CARDIAC ARREST

Abstract

SESSION TITLE: Critical Care Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: Acute kidney injury after cardiac arrest(CA) is common and reported in up to 50% of patients. This study investigated the survival outcomes of patients with in-hospital cardiac arrest (IHCA) who develop AKI requiring renal replacement therapy (RRT). METHODS: We conducted a retrospective study utilizing electronic medical records from January 1st, 2018 and December 31st, 2018 at the Cleveland Clinic medical system. The study participants were patients above age 18 years who were admitted to the hospital and had IHCA. Cardiac arrest was defined as: as the loss of circulation prompting resuscitation with chest compressions, defibrillation and ACLS protocol activation. Patients who arrested in the emergency room, and outside of the hospital and patients with length of stay exceeding 180 days were excluded. The Kaplan–Meier plot and log rank test were used for survival outcome (Total length of hospital stay in days and survival at hospital discharge as censored information). All analyses were two-tailed and were performed at a significance level of 0.05. SAS 9.3 software (SAS Institute, Cary, NC) was used for all analyses. RESULTS: Of a total of 592 patients with consecutive IHCA, 549 subjects met the inclusion criteria, 73 patients underwent to RRT after IHCA and 476 did not undergo RRT. The mean age of patients in the RRT group was 62.8 ± 13.5 years. 56.9% of them being males. 20.5% of the subjects had a diagnosis of Chronic kidney disease not requiring dialysis. The Kaplan–Meier plot and log rank test were used for survival outcome and based on the log rank test (p= 0.0002) shows that survival curve differs in time among the RRT vs non –RRT groups, the data suggest patients showed that 73 patients who underwent to CRRT had improved survival. CONCLUSIONS: In-hospital cardiac arrest is an acute event that can potentially affect any hospitalized patient, and traditionally it has been a condition of poor outcomes. Previous data has shown around two-thirds of patients who suffered CA had at least two extra-cerebral organ dysfunctions, including acute kidney injury with an incidence up to 50%. However, the data has been described mostly on out-hospital cardiac arrest patients. AKI requiring RRT traditionally has been associated with bad prognosis in patients who are critically ill; however, in our population, does not appear to be the case. Our data suggest that patients who received RRT do not have worse survival at hospital discharge or length of stay compared with patients who did not have require RRT. CLINICAL IMPLICATIONS: Our study reassures that need for renal replacement therapy by itself may not be a poor prognostic indicator in patient’s post cardiac arrest and early CRRT may have beneficial effects in patients with AKI post cardiac arrest. Further studies may be needed in this regard. DISCLOSURES: No relevant relationships by Adeel Ahmed, source=Web Response No relevant relationships by Bilal Alam, source=Web Response No relevant relationships by Narendrakumar Alappan, source=Web Response No relevant relationships by Sanchit Chawla, source=Web Response No relevant relationships by Sany Kumar, source=Web Response No relevant relationships by Oscar Perez, source=Web Response No relevant relationships by Yacoub Sallam, source=Web Response No relevant relationships by Akhil Singhal, source=Web Response