Examining the Relationship Between Timing of Continuous Veno-Venus Hemodialysis (CVVHD) and Fulminant Liver Failure Outcomes in the ICU

Abstract

SESSION TITLE: Original Investigations in Critical Care SESSION TYPE: Original Investigation Slide PRESENTED ON: Sunday, October 23, 2016 at 04:30 PM - 05:30 PM PURPOSE: To Examine the relationship between the timing of Continuous Veno-Venus Hemodialysis (CVVHD) and Morbidity and Mortality Outcome from Fulminant Liver Failure METHODS: All patients with Fulminant liver failure and acute renal failure defined by The Modification of Diet in Renal Disease (MDRD) admitted in the intensive care unit were included in the study. Parameters and outcomes that were reviewed were: Age/date of birth, gender, ethnicity, height, weight, BMI, previous kidney disease, adminittration bicarbonate during ICU stay, MELD score, etiology of liver failure, use of pressors at the time of initiation of CVVHD, number of pressor requirements, average creatinine before and after CVVHD started, time of CVVHD start and time of CVVHD start, encephalopathy grade, time of CVVHD initiation and duration of CVVHD to transplant, medications, liver function results, outcome after hospitalization (death within 30 days vs discharge), etiology of liver failure, time on and off CVVHD, renal function enzyme test results, morbidity (time off ventilator, mental status improvement etc) and mortality. RESULTS: 450 charts were reviewed from 7/12014-6/31/2015, out of which 37 were included in our study criteria. 23 patients received CVVHD and identified as the study group. 14 patients did not receive CVVHD and were identified as the control group. The average age was 49 in the study group and 42 in the control group. Average length of stay in the ICU was 302 hours in the study group and 175 hours in the control group. Average MELD was 24.9 in the study group and 25.8 in the control group. 7/23 (30.4%) patients survived in the study group and 6/14 (42.8%) of the patients survived in the control group. Only 2/14 (14%) patients in the control group were on vasopressor support as opposed to 12/23 (52%) in the study group prior to the initiation of CVVHD. After CVVHD, there was a trend in increase in pressor requirement and initiation of pressors in the study group resulting in 19/23 (82.6%) patients to be on vasopressor support. There was no change in vasopressor support requirement in the control group.The patients in both groups had similar etiologies for their fulminant hepatic failures. CONCLUSIONS: Initiation of CVVHD does not have a significant impact in outcomes of fulminant liver patients. Patients should be very carefully selected before initiation of CVVHD due to its effects on vasopressor requirements and possibly worsening outcomes resulting in increased morbidity and mortality. CLINICAL IMPLICATIONS: Use of CVVHD in the fulminant liver patient population is a new modality that needs further studies to decide its complete efficacy. DISCLOSURE: The following authors have nothing to disclose: John Kileci, Yuriy Takhalov, Keith Guevarra No Product/Research Disclosure Information