Mortality of Sepsis in Patients With Rheumatoid Arthritis: A Single-Center Retrospective Analysis and Comparison With a Control Group

Introduction/Background: Patients with rheumatoid arthritis (RA) have a high risk of infections that may require intensive care unit (ICU) admission in case of resulting sepsis. Data regarding the mortality of these patients are very limited. This study investigated clinical characteristics and outcomes of patients with RA admitted to the ICU for sepsis and compared the results to a control cohort without RA. Methods: All patients with RA as well as sex-, age-, and admission year-matched controls admitted to the ICU of a university hospital for sepsis between 2006 and 2019 were retrospectively analyzed. Mortality was calculated for both the groups, and multivariate logistic regression was used to determine independent risk factors for sepsis mortality. The positive predictive value of common ICU scores was also investigated. Results: The study included 49 patients with RA (mean age 67.2 ± 9.0 years, 63.3% females) and 51 matched controls (mean age 67.4 ± 9.5 years, 64.7% females). Among the patients with RA, 42.9% (n = 21) were treated with conventional synthetic (cs) disease-modifying antirheumatic drugs (DMARDs) and 30.6% (n = 15) received glucocorticoids only. Seven (14.3%) patients received biologic (b) DMARDs. The hospital mortality was higher among patients with RA (42.9% vs 15.7%, P = .0016). Rheumatoid arthritis was independently associated with mortality in multivariate logistic regression ( P = .001). In patients with RA, renal replacement therapy ( P = .024), renal failure ( P = .027), and diabetes mellitus ( P = .028) were independently associated with mortality. Acute Physiology and Chronic Health Evaluation II (APACHE II), Simplified Acute Physiology Score II (SAPS II), and Sequential Organ Failure Assessment (SOFA) scores were good predictors of sepsis mortality in patients with RA (APACHE II area under the curve [AUC]: 0.78, P = .001; SAPS II AUC: 0.78, P < .001; SOFA AUC 0.78, P < .001), but their predictive power was higher among controls. Conclusions: Hospital sepsis mortality was higher in patients with RA than in controls. Rheumatoid arthritis itself is independently associated with an increased sepsis mortality. Renal replacement therapy, renal failure, and diabetes were associated with an increased mortality. Common ICU scores were less well predictors of sepsis mortality in patients with RA compared to non-RA controls.

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Outcome of Patients With Necrotizing Vasculitis Admitted to the Intensive Care Unit (ICU) for Sepsis: Results of a Single-Centre Retrospective Analysis

Journal of Intensive Care Medicine ◽

10.1177/0885066620953768 ◽

2020 ◽

pp. 088506662095376

Author(s):

Marco Krasselt ◽

Christoph Baerwald ◽

Sirak Petros ◽

Olga Seifert

Keyword(s):

Intensive Care Unit ◽

Logistic Regression ◽

Intensive Care ◽

Tertiary Hospital ◽

Simplified Acute Physiology Score ◽

Apache Ii ◽

Necrotizing Vasculitis ◽

Multivariate Logistic Regression ◽

Sepsis Mortality ◽

Saps Ii

Introduction/Background: Vasculitis patients have a high risk for infections that may require intensive care unit (ICU) treatment in case of resulting sepsis. Since data on sepsis mortality in this patient group is limited, the present study investigated the clinical characteristics and outcomes of vasculitis patients admitted to the ICU for sepsis. Methods: The medical records of all necrotizing vasculitis patients admitted to the ICU of a tertiary hospital for sepsis in a 13-year period have been reviewed. Mortality was calculated and multivariate logistic regression was used to determine independent risk factors for sepsis mortality. Moreover, the predictive power of common ICU scores was further evaluated. Results: The study included 34 patients with necrotizing vasculitis (mean age 69 ± 9.9 years, 35.3% females). 47.1% (n = 16) were treated with immunosuppressives (mostly cyclophosphamide, n = 35.3%) and 76.5% (n = 26) received glucocorticoids. Rituximab was used in 4 patients (11.8%).The in-hospital mortality of septic vasculitis patients was 41.2%. The Sequential Organ Failure Assessment (SOFA) score (p = 0.003) was independently associated with mortality in multivariate logistic regression. Acute Physiology And Chronic Health Evaluation II (APACHE II), Simplified Acute Physiology Score II (SAPS II) and SOFA scores were good predictors of sepsis mortality in the investigated vasculitis patients (APACHE II AUC 0.73, p = 0.02; SAPS II AUC 0.81, p < 0.01; SOFA AUC 0.898, p < 0.0001). Conclusions: Sepsis mortality was high in vasculitis patients. SOFA was independently associated with mortality in a logistic regression model. SOFA and other well-established ICU scores were good mortality predictors.

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Comparison of Hemostatic Disturbances between Patients on Capd and Patients on Hemodialysis

Peritoneal Dialysis International ◽

10.1177/089686080102100209 ◽

2001 ◽

Vol 21 (2) ◽

pp. 158-167 ◽

Cited By ~ 38

Author(s):

Jolanta Malyszko ◽

Jacek S. Malyszko ◽

Michal Mysliwiec

Keyword(s):

Renal Failure ◽

Platelet Aggregation ◽

Renal Replacement Therapy ◽

Replacement Therapy ◽

Factor Vii ◽

Control Group ◽

End Stage Renal Failure ◽

Lipoprotein A ◽

Uremic Patients ◽

End Stage

Objective Disturbances in hemostasis are common findings in uremic patients. Both bleeding diathesis and thrombosis are observed. The purpose of this study was to assess whether renal replacement therapy in the form of hemodialysis (HD) or continuous ambulatory peritoneal dialysis (CAPD) affects coagulation and fibrinolysis in patients with end-stage renal failure. Design Comparison of hemostatic measures in patients on CAPD, HD, and matched healthy controls. Setting Department of Nephrology and Internal Medicine, Bialystok University School of Medicine. Patients and Methods Twenty-four HD patients and 23 CAPD patients were evaluated with respect to platelet aggregation, hemostatic parameters, serum lipids, lipoprotein(a), and cytokines [tumor necrosis factor alpha (TNFα) and interleukin-1 (IL-1)]. Interventions Four exchanges of CAPD per day, using 2.0 L dialysate over a period of 25 ± 31 months; or 4 – 5 hours of HD 3 times per week for a period of 31 ± 22 months. Results Platelet aggregation in whole blood and platelet-rich plasma was significantly impaired in both groups of dialyzed patients compared to healthy volunteers. Markers of endothelial cell injury (thrombomodulin and von Willebrand factor) were significantly higher in HD and CAPD patients compared to the control group. A similar pattern of changes was observed for lipoprotein(a), fibrinogen, tissue factor pathway activity, and factor VII activity. Activity of factor X was significantly enhanced in CAPD compared to HD patients and controls. Euglobulin clot lysis time was significantly prolonged in HD and CAPD patients over controls, being more prolonged in CAPD patients. Markers of ongoing coagulation (thrombin–antithrombin complexes and prothrombin fragments 1+2) were higher in uremic patients, significantly higher in CAPD than in HD. A marker of ongoing fibrinolysis (plasmin–antiplasmin complexes) was higher in uremic patients but was lower in CAPD than in HD patients. Concentrations of TNFα and IL-1 were higher in HD than in CAPD patients. Conclusion Patients on CAPD showed evidence of a higher degree of hypercoagulation than HD patients. Thus, hemostatic abnormalities in end-stage renal failure may be affected to some extent by the choice of renal replacement therapy.

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Prognostic factors in patients treated with extracorporeal membrane oxygenation and continuous renal replacement therapy

Perfusion ◽

10.1177/02676591211011039 ◽

2021 ◽

pp. 026765912110110

Author(s):

Toshiki Hiramatsu ◽

Shigemitsu Shimizu ◽

Hidenobu Koga

Keyword(s):

Prognostic Factors ◽

Renal Replacement Therapy ◽

Extracorporeal Membrane Oxygenation ◽

Continuous Renal Replacement Therapy ◽

Replacement Therapy ◽

Intracranial Hemorrhage ◽

Apache Ii ◽

Poor Prognostic Factor ◽

Saps Ii ◽

Membrane Oxygenation

Introduction: Extracorporeal membrane oxygenation (ECMO) and Continuous renal replacement therapy (CRRT) are treatments for critically ill patients with respiratory failure and acute kidney injury. However, no reliable factors have been identified to predict survival in patients treated with both ECMO and CRRT. The aim of this study was to identify prognostic factors for discharging intensive care unit (ICU) patients who required CRRT during ECMO. Methods: We retrospectively analyzed data from patients who required CRRT in addition to the ECMO, between April 2015 and March 2018. The patients were divided into two groups: patients who survived and patients who died during ICU hospitalization. We determined their demographic and clinical characteristics, Acute Physiology and Chronic Health Evaluation II (APACHE II) scores, Simplified Acute Physiology Score II (SAPS II) scores, and sequential organ failure assessment (SOFA) scores. Further, we assessed whether these characteristics differed between individuals who did or did not survive the ICU hospitalization. Results: We found that the APACHE II and SAPS II scores differed significantly between both ECMO and CRRT treated patients who did or did not survive hospitalization. Further, intracranial hemorrhage during ECMO and CRRT therapy was associated with lower survival rate. Conclusions: Using APACHE II and SAPS II scores might be helpful in making treatment decisions for patients treated with ECMO and CRRT. Intracranial hemorrhage could be a poor prognostic factor. Our findings indicate the potential utility of APACHE II and SAPS II scores to predict mortality in patients treated with both ECMO and CRRT.

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Sepsis Mortality Is high in Patients With Connective Tissue Diseases Admitted to the Intensive Care Unit (ICU)

Journal of Intensive Care Medicine ◽

10.1177/0885066621996257 ◽

2021 ◽

pp. 088506662199625

Author(s):

Marco Krasselt ◽

Christoph Baerwald ◽

Sirak Petros ◽

Olga Seifert

Keyword(s):

Intensive Care Unit ◽

Logistic Regression ◽

Intensive Care ◽

Systemic Sclerosis ◽

Connective Tissue ◽

Sofa Score ◽

Connective Tissue Diseases ◽

Multivariate Logistic Regression ◽

Sepsis Mortality ◽

Saps Ii

Objectives: Patients with connective tissue diseases (CTD) such as systemic lupus erythematosus (SLE) have an increased risk for infections. This study investigated the outcome and characteristics of CTD patients under intensive care unit (ICU) treatment for sepsis. Methods: A single-center retrospective analysis was conducted and reviewed all patients with a CTD diagnosis admitted to the ICU of a university hospital for sepsis between 2006 and 2019. Mortality was computed and multivariate logistic regression was used to detect independent risk factors for sepsis mortality. Furthermore, the positive predictive value of ICU scores such as Sequential Organ Failure Assessment (SOFA) score was evaluated. Results: This study included 44 patients with CTD (mean age 59.8 ± 16.1 years, 68.2% females), most of them with a diagnosed SLE (61.4%) followed by systemic sclerosis (15.9%). 56.8% (n = 25) were treated with immunosuppressives and 81.8% (n = 36) received glucocorticoids. Rituximab was used in 3 patients (6.8%). The hospital mortality of septic CTD patients was high with 40.9%. It was highest among systemic sclerosis (SSc) patients (85.7%). SOFA score and diagnosis of SSc were independently associated with mortality in multivariate logistic regression ( P = 0.004 and 0.03, respectively). The Simplified Acute Physiology Score II (SAPS II), SOFA and Acute Physiology and Chronic Health Evaluation II (APACHE II) scores were good predictors of sepsis mortality in the investigated cohort (SAPS II AUC 0.772, P = 0.002; SOFA AUC 0.756, P = 0.004; APACHE II AUC 0.741, P = 0.007). Conclusions: In-hospital sepsis mortality is high in CTD patients. SSc diagnoses and SOFA were independently associated with mortality. Additionally, common ICU scores were good predictors for mortality.

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Veno–venous continuous renal replacement therapy for burned patients with acute renal failure

Burns ◽

10.1016/s0305-4179(00)00010-3 ◽

2000 ◽

Vol 26 (7) ◽

pp. 638-643 ◽

Cited By ~ 33

Author(s):

Richard Tremblay ◽

Jean Ethier ◽

Serge Quérin ◽

Vincent Béroniade ◽

Pierre Falardeau ◽

...

Keyword(s):

Renal Failure ◽

Acute Renal Failure ◽

Renal Replacement Therapy ◽

Continuous Renal Replacement Therapy ◽

Replacement Therapy

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Acute Renal Failure Requiring Renal Replacement Therapy: Unusual Presentation of Multisystem Inflammatory Syndrome in Children

Journal of Paediatrics and Child Health ◽

10.1111/jpc.15715 ◽

2021 ◽

Vol 57 (10) ◽

pp. 1724-1725

Author(s):

Rakesh K Pilania ◽

Swati Dokania ◽

Amber Kumar ◽

Reyaz Ahmad ◽

Shikha Malik ◽

...

Keyword(s):

Renal Failure ◽

Acute Renal Failure ◽

Renal Replacement Therapy ◽

Replacement Therapy ◽

Unusual Presentation ◽

Inflammatory Syndrome

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Effect of acute renal failure requiring renal replacement therapy on outcome in critically ill patients*

Critical Care Medicine ◽

10.1097/00003246-200209000-00016 ◽

2002 ◽

Vol 30 (9) ◽

pp. 2051-2058 ◽

Cited By ~ 595

Author(s):

Philipp G. H. Metnitz ◽

Claus G. Krenn ◽

Heinz Steltzer ◽

Thomas Lang ◽

Jürgen Ploder ◽

...

Keyword(s):

Renal Failure ◽

Acute Renal Failure ◽

Renal Replacement Therapy ◽

Replacement Therapy ◽

Critically Ill ◽

Critically Ill Patients

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Continuous Hemodiafiltration in Children

PEDIATRICS ◽

10.1542/peds.85.5.819 ◽

1990 ◽

Vol 85 (5) ◽

pp. 819-823

Author(s):

Nancy A. Bishof ◽

Thomas R. Welch ◽

C. Frederic Strife ◽

Frederick C. Ryckman

Keyword(s):

Renal Failure ◽

Acute Renal Failure ◽

Peritoneal Dialysis ◽

Renal Replacement Therapy ◽

Replacement Therapy ◽

Effective Means ◽

Tumor Lysis Syndrome ◽

Intermittent Hemodialysis ◽

Tumor Lysis ◽

Continuous Arteriovenous Hemofiltration

Continuous arteriovenous hemofiltration is a form of renal replacement therapy whereby small molecular weight solutes and water are removed from the blood via convection, alleviating fluid overload and, to a degree, azotemia. It has been used in many adults and several children. However, in patients with multisystem organ dysfunction and acute renal failure, continuous arteriovenous hemofiltration alone may not be sufficient for control of azotemia; intermittent hemodialysis or peritoneal dialysis may be undesirable in such unstable patients. Recently, the technique of continuous arteriovenous hemodiafiltration has been used in many severely ill adults. We have used continuous arteriovenous hemodiafiltration in four patients at Children's Hospital Medical Center. Patient 1 suffered perinatal asphyxia and oliguria while on extracorporeal membrane oxygenation. Patients 2 and 4 both had Burkitt lymphoma and tumor lysis syndrome. Patient 3 had septic shock several months after a bone marrow transplant. All had acute renal failure and contraindications to hemodialysis or peritoneal dialysis. A blood pump was used in three of the four patients, while spontaneous arterial flow was adequate in one. Continuous arteriovenous hemodiafiltration was performed for varying lengths of time, from 11 hours to 7 days. No patient had worsening of cardiovascular status or required increased pressor support during continuous arteriovenous hemodiafiltration. The two survivors (patients 2 and 4) eventually recovered normal renal function. Continuous arteriovenous hemodiafiltration is a safe and effective means of renal replacement therapy in the critically ill child. It may be ideal for control of the metabolic and electrolyte abnormalities of the tumor lysis syndrome.

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