UTILIZATION AND CLINICAL OUTCOMES IN PATIENTS REQUIRING HEMODIALYSIS 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 who require hemodialysis (HD) both for acute renal failure and ESRD in the MICU are not well defined. 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 admitted to the MICU with the need for HD, both acutely and those with chronic HD. Our purpose was to evaluate reason for admission, factors affecting outcome and to assess the performance of SAPS-II and SOFA scores to predict mortality for patients admitted to the MICU requiring HD. METHODS: Retrospective chart review was performed on 194 patients who were admitted to the MICU at two tertiary centers and required hemodialysis 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. RESULTS: The mean age of patients was 65.4 (±16.3), of which 56.2% were male. The most common indications for admission were acute renal failure/hyperkalemia requiring HD (26.3%), respiratory failure (25.8%) and sepsis (17%). Of the patients with respiratory failure, 38% had flash pulmonary edema. ICU mortality was 19.6%, in-hospital mortality was 25.3%, ICU readmission rate was 9.3% and 30-day readmission was 25.8%. Average MICU length of stay (LOS) was 5.02 days, mean SOFA score was 6.74±2.53, mean SAPS-II score was 51.7±19.2, 45.4% were on mechanical ventilation and 10.3% required vasopressor support. Of note, the mortality for all patients admitted to the MICU during the study period was 14.7%. Patients had either ESRD (113/194), acute on chronic kidney injury (39/194) or acute kidney injury (42/194). The ICU mortality for patients admitted with ARF was 22.2% vs 17.0% for those admitted with ESRD. Higher SAPS-II and SOFA scores were associated with mortality in the ICU (p<0.01). Presence of mechanical ventilation (MV) and requirement of vasopressor support were also associated with ICU mortality. CONCLUSIONS: The most common indication for MICU admission in patients requiring HD was acute renal failure/hyperkalemia, followed by respiratory failure. Outcomes with patients requiring HD in the MICU is poor, especially if they require additional organ support, such as MV or vasopressor use. SAPS-II and SOFA scores are useful predictive models for MICU mortality in these patients. The ICU LOS and mortality were higher for patients requiring dialysis for any reason as compared to the overall MICU LOS and mortality. CLINICAL IMPLICATIONS: Outcomes of patients requiring HD admitted to ICU is poor, especially if they require other organ support. SAPS-II and SOFA scores perform well as predictors of 30-day 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