Shawwa et al reported risk factors for in-hospital mortality for a patient requiring continuous renal replacement therapy (CRRT). This can help to identify a patient who may benefit from more aggressive management. The authors are from the Mayo Clinic in Rochester.
Patient selection: hospitalized adult requiring CRRT
Criteria for hypotension - any of the following:
(1) mean arterial blood pressure < 60 mm Hg
(2) systolic blood pressure < 90 mm Hg
(3) decline in systolic blood pressure > 40 mm Hg from baseline
(4) increased vasopressor requirement
(5) positive fluid balance > 500 mL
Risk factors for in-hospital mortality:
(1) elevated SOFA score (OR 1.13 per unit)
(2) age (OR 1.02 per year)
(3) number of days between admission and CRRT initiation (OR 1.1 per day delay)
(4) hypotension within 1 hour of starting CRRT (OR 1.54)
(5) acute kidney injury (OR 1.54)
(6) use of high bicarbonate (32 mEq/L) replacement fluid (OR 1.52)
