Characteristics And Outcomes of Sepsis Patients With And Without COVID-19

Abstract Background: The aim of this study was to describe and compare clinical characteristics and outcomes in critically ill septic patients with and without COVID-19.Methods: From February 2020 to March 2021, patients from surgical and medical ICUs at the University Hospital Dresden were screened for sepsis. Patient characteristics and outcomes were assessed descriptively. Patient survival was analyzed using the Kaplan-Meier estimator. Associations between in-hospital mortality and risk factors were modeled using robust Poisson regression, which facilitates derivation of adjusted relative risks.Results: In 177 ICU patients treated for sepsis, COVID-19 was diagnosed and compared to 191 septic ICU patients without COVID-19. Age and sex did not differ significantly between sepsis patients with and without COVID-19, but SOFA score at ICU admission was significantly higher in septic COVID-19 patients. In-hospital mortality was significantly higher in COVID-19 patients with 59% compared to 29% in Non-COVID patients. Statistical analysis resulted in an adjusted relative risk for in-hospital mortality of 1.74 (95%-CI=1.35-2-24) in the presence of COVID-19 compared to other septic patients. Age, procalcitonin maximum value over 2 ng/ml, need for renal replacement therapy, need for invasive ventilation and septic shock were identified as additional risk factors for in-hospital mortality.Conclusion: COVID-19 was identified as independent risk factor for higher in-hospital mortality in sepsis patients. The need for invasive ventilation and renal replacement therapy as well as the presence of septic shock and higher PCT should be considered to identify high-risk patients.

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Renal Replacement Therapy in Intensive Care Unit at a Tertiary Care Center in Nepal

Nepal Medical College Journal ◽

10.3126/nmcj.v21i1.24858 ◽

2019 ◽

Vol 21 (1) ◽

pp. 74-79

Author(s):

Pramod Kumar Chhetri ◽

DN Manandhar ◽

P Poudel ◽

S Baidya ◽

SB Raju ◽

...

Keyword(s):

Intensive Care Unit ◽

Septic Shock ◽

Intensive Care ◽

Renal Replacement Therapy ◽

Hospital Mortality ◽

Replacement Therapy ◽

Care Center ◽

Tertiary Care ◽

Intermittent Hemodialysis ◽

Low Efficiency

Acute kidney injury is a major complication in intensive care unit patients. It is associated with increased in-hospital mortality and length of stay. The provision of renal replacement therapy in intensive care is not widely available in resource poor countries like Nepal. The study aims to look into clinical profile and outcome of patients who received renal replacement therapy in intensive care unit. It was an observational study done from 1st October 2016 till 30th September 2017. Patient’s demographic data, indications, biochemical tests, outcomes, modality of renal replacement therapy were recorded. Statistical package for the social sciences version 17 was used for statistical analysis. There were total of 649 admissions in intensive care, among which 148 had kidney related complications. Of 148 patients, 69 (47%) received renal replacement therapy. Mean age, urea and creatinine on admission were 50.17 ± 18.42 years, 174.54 ± 63.46 mg/dl and 8.05 ± 3.49 mg/ dl respectively. They underwent 4.32 ± 3.09 sessions and 14.94 ± 10.88 hours of renal replacement therapy. Total 42 (61%) had septic shock on admission and underwent sustained low efficiency dialysis as the modality of renal replacement therapy. In-hospital mortality was 19 (28%). Presence of septic shock on admission and mean number of ionotropes required 2.05 ± 1.12 was statistically significant for in-hospital mortality (p=0.01). About half of the patients were on mechanical ventilation which was statistically significant for in-hospital mortality (p<0.001). Sustained low efficiency dialysis can be done in patients on ionotropes and patients can be switched over to intermittent hemodialysis.

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Procalcitonin and N-Terminal Pro-B-Type Natriuretic Peptide for Prognosis in Septic Acute Kidney Injury Patients Receiving Renal Replacement Therapy

Blood Purification ◽

10.1159/000501388 ◽

2019 ◽

Vol 48 (3) ◽

pp. 262-271 ◽

Cited By ~ 1

Author(s):

Xiaohua Sheng ◽

Jingye Yang ◽

Gang Yu ◽

Yang Fei ◽

Hongda Bao ◽

...

Keyword(s):

Acute Kidney Injury ◽

Renal Replacement Therapy ◽

Hospital Mortality ◽

Replacement Therapy ◽

Natriuretic Peptide ◽

Kidney Injury ◽

University Hospital ◽

Kaplan Meier ◽

Septic Acute Kidney Injury ◽

Significant Difference

Background: Sepsis is a complex clinical syndrome leading to severe sepsis and septic shock. It is very common in the intensive care unit with high mortality. Thus, judging its prognosis is extremely important. Procalcitonin (PCT) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels are commonly elevated in sepsis patients, but only a few are discussed in the septic acute kidney injury patients (AKI) who received renal replacement therapy (RRT). Our study is aimed at investigating the prognostic value of PCT and NT-proBNP in septic AKI patients who received RRT. Methods: This was a retrospective study of septic AKI patients who underwent RRT in a Chinese university hospital. All enrolled patients tested PCT and NT-proBNP at RRT initiation. PCT and NT-proBNP levels were compared between the survivors and non-survivors. Receiver operating characteristic (ROC) curves of the 2 biomarkers were performed for predicting in-hospital mortality. According to the median value of PCT (16.2 ng/mL) and NT-proBNP (10,271 pg/mL), patients were divided into 4 groups (low PCT and low NT-proBNP; high PCT and low NT-proBNP; low PCT and high NT-proBNP; high PCT and high NT-proBNP). The Kaplan-Meier survival curves were used to analyze the 28-day survival rate in the 4 groups. Results: A total of 81 patients were enrolled in the study. Of which, 48 (59.3%) patients died during hospitalization. The median of NT-proBNP in non-survivors was significantly higher than in survivors (p = 0.001), while PCT had no significant difference (p = 0.412). The area under the ROC curve of PCT and NT-proBNP for predicting in-hospital mortality was 0.561 (95% CI 0.426–0.695) and 0.729 (95% CI 0.604–0.854). Kaplan-Meier survival curve analysis showed that increased NT-proBNP level was associated with 28-day mortality while combined with PCT there was no statistical difference in 4 different level groups. Conclusion: NT-proBNP has a certain predictive value for the prognosis in septic AKI patients who received RRT. It seems that the initial PCT value for prognosis is limited. The combination of PCT and NT-proBNP to evaluate the prognosis in these critically ill patients is currently unclear.

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Prevalence and risk factors of hemodynamic instability associated with preload-dependence during continuous renal replacement therapy in a prospective observational cohort of critically ill patients

Annals of Intensive Care ◽

10.1186/s13613-021-00883-9 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Guillaume Chazot ◽

Laurent Bitker ◽

Mehdi Mezidi ◽

Nader Chebib ◽

Paul Chabert ◽

...

Keyword(s):

Risk Factors ◽

Renal Replacement Therapy ◽

Continuous Renal Replacement Therapy ◽

Replacement Therapy ◽

Kidney Injury ◽

Hemodynamic Instability ◽

Single Center ◽

Icu Patients ◽

Fluid Removal ◽

Observational Cohort

Abstract Background Hemodynamic instability is a frequent complication of continuous renal replacement therapy (CRRT). Postural tests (i.e., passive leg raising in the supine position or Trendelenburg maneuver in the prone position) combined with measurement of cardiac output are highly reliable to identify preload-dependence and may provide new insights into the mechanisms involved in hemodynamic instability related to CRRT (HIRRT). We aimed to assess the prevalence and risk factors of HIRRT associated with preload-dependence in ICU patients. We conducted a single-center prospective observational cohort study in ICU patients with acute kidney injury KDIGO 3, started on CRRT in the last 24 h, and monitored with a PiCCO® device. The primary endpoint was the rate of HIRRT episodes associated with preload-dependence during the first 7 days after inclusion. HIRRT was defined as the occurrence of a mean arterial pressure below 65 mmHg requiring therapeutic intervention. Preload-dependence was assessed by postural tests every 4 h, and during each HIRRT episode. Data are expressed in median [1st quartile–3rd quartile], unless stated otherwise. Results 42 patients (62% male, age 69 [59–77] year, SAPS-2 65 [49–76]) were included 6 [1–16] h after CRRT initiation and studied continuously for 121 [60–147] h. A median of 5 [3–8] HIRRT episodes occurred per patient, for a pooled total of 243 episodes. 131 episodes (54% [CI95% 48–60%]) were associated with preload-dependence, 108 (44%, [CI95% 38–51%]) without preload-dependence, and 4 were unclassified. Multivariate analysis (using variables collected prior to HIRRT) identified the following variables as risk factors for the occurrence of HIRRT associated with preload-dependence: preload-dependence before HIRRT [odds ratio (OR) = 3.82, p < 0.001], delay since last HIRRT episode > 8 h (OR = 0.56, p < 0.05), lactate (OR = 1.21 per 1-mmol L−1 increase, p < 0.05), cardiac index (OR = 0.47 per 1-L min−1 m−2 increase, p < 0.001) and SOFA at ICU admission (OR = 0.91 per 1-point increase, p < 0.001). None of the CRRT settings was identified as risk factor for HIRRT. Conclusions In this single-center study, HIRRT associated with preload-dependence was slightly more frequent than HIRRT without preload-dependence in ICU patients undergoing CRRT. Testing for preload-dependence could help avoiding unnecessary decrease of fluid removal in preload-independent HIRRT during CRRT.

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Prevalence and Risk Factors of Hemodynamic Instability Associated with Preload-Dependence During Continuous Renal Replacement Therapy in a Prospective Observational Cohort of Critically Ill Patients

10.21203/rs.3.rs-136892/v1 ◽

2020 ◽

Author(s):

Guillaume CHAZOT ◽

Laurent BITKER ◽

Mehdi MEZIDI ◽

Nader CHEBIB ◽

Paul CHABERT ◽

...

Keyword(s):

Risk Factors ◽

Renal Replacement Therapy ◽

Continuous Renal Replacement Therapy ◽

Replacement Therapy ◽

Kidney Injury ◽

Hemodynamic Instability ◽

Single Center ◽

Icu Patients ◽

Fluid Removal ◽

Observational Cohort

Abstract BackgroundHemodynamic instability is a frequent complication of continuous renal replacement therapy (CRRT). Postural tests (i.e. passive leg raising in the supine position or Trendelenburg maneuver in the prone position) combined with measurement of cardiac output are highly reliable to identify preload-dependence and may provide new insights into the mechanisms involved in hemodynamic instability related to CRRT (HIRRT). We aimed to assess the prevalence and risk factors of HIRRT associated with preload-dependence in ICU patients.MethodsWe conducted a single-center prospective observational cohort study in ICU patients with acute kidney injury KDIGO 3, started on CRRT in the last 24 hours, and monitored with a PiCCO® device. The primary endpoint was the rate of HIRRT episodes associated with preload-dependence during the first 7 days after inclusion. HIRRT was defined as the occurrence of a mean arterial pressure below 65 mm Hg requiring therapeutic intervention. Preload-dependence was assessed by postural tests every 4 hours, and during each HIRRT episode. Data are expressed in median [1rst quartile-3rd quartile], unless stated otherwise.Results42 patients (62% male, age 69 [59–77] year, SAPS-2 65 [49–76]) were included 6 [1–16] hours after CRRT initiation and studied continuously for 121 [60–147] hours. A median of 5 [3–8] HIRRT episodes occurred per patient, for a pooled total of 243 episodes. 131 episodes (54% [CI95%: 48%-60%]) were associated with preload-dependence, 108 (44%, [CI95%: 38%-51%]) without preload-dependence, and 4 were unclassified. Multivariate analysis (using variables collected prior to HIRRT) identified the following variables as risk factors for the occurrence of HIRRT associated with preload-dependence: preload-dependence before HIRRT (odd ratio (OR) = 3.82, p < 0.001), delay since last HIRRT episode > 8 hours (OR = 0.56, p < 0.05), lactate (OR = 1.21 per 1-mmol.L− 1 increase, p < 0.05), cardiac index (OR = 0.47 per 1-L.min− 1.m− 2 increase, p < 0.001) and SOFA at ICU admission (OR = 0.91 per 1-point increase, p < 0.001). None of the CRRT settings was identified as risk factor for HIRRT.Conclusions:In this single center study, HIRRT associated with preload-dependence was slightly more frequent than HIRRT without preload-dependence in ICU patients undergoing CRRT. Testing for preload-dependence to adjust fluid removal by CRRT could help preventing HIRRT occurrence during CRRT.

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The epidemiology of, and risk factors for, mortality from severe sepsis and septic shock in a tertiary-care university hospital setting

Epidemiology and Infection ◽

10.1017/s0950268809002027 ◽

2009 ◽

Vol 137 (9) ◽

pp. 1333-1341 ◽

Cited By ~ 32

Author(s):

B. KHWANNIMIT ◽

R. BHURAYANONTACHAI

Keyword(s):

Risk Factors ◽

Septic Shock ◽

Severe Sepsis ◽

Hospital Mortality ◽

Tertiary Care ◽

Hospital Setting ◽

University Hospital ◽

Apache Ii Score ◽

Sepsis And Septic Shock ◽

Hospital Acquired

SUMMARYThis study investigated the clinical characteristics of, and outcomes and risk factors for hospital mortality of 390 patients admitted with severe sepsis or septic shock in an intensive care unit (ICU). Prospectively collected data from patients collected between 1 July 2004 and 30 June 2006 were analysed. Overall hospital mortality was 49·7% and comorbidities were found in 40·3% of patients, the most common of which was haematological malignancy. The respiratory tract was the most common site of infection (50%). Hospital-acquired infections accounted for 55·6% of patients with Gram-negative bacteria predominant (68%). Multivariate analysis showed that acute respiratory distress syndrome, pulmonary artery catheter placement, comorbidities, hospital-acquired infection, APACHE II score and maximum LOD score, were independent risk factors for hospital mortality. In conclusion, severe sepsis and septic shock are common causes of ICU admission. Patients with risk factors for increased mortality should be carefully monitored and aggressive treatment administered.

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Acute Renal Injury in Cardiac Surgery Patients

Russian Sklifosovsky Journal Emergency Medical Care ◽

10.23934/2223-9022-2020-9-3-383-390 ◽

2020 ◽

Vol 9 (3) ◽

pp. 383-390

Author(s):

S. I. Rey ◽

G. A. Berdnikov ◽

L. N. Zimina ◽

N. V. Rubtsov ◽

M. K. Mazanov ◽

...

Keyword(s):

Risk Factors ◽

Cardiac Surgery ◽

Renal Replacement Therapy ◽

Serum Creatinine ◽

Hospital Mortality ◽

Replacement Therapy ◽

Postoperative Period ◽

Renal Injury ◽

Acute Renal Injury ◽

Group 1

Background. Acute kidney injury following cardiac surgery remains a common and serious complication.Aim of study. To identify risk factors for the development and morphological features of acute renal injury, to assess the use of renal replacement therapy in patients after cardiac surgery.Material and methods. The study involved 66 patients who were treated in the Department of Cardiac Resuscitation of the N.V. Sklifosovsky Research Institute for Emergency Medicine from 2009 to 2018. Of these, 45 men (68.2%) and 21 women (31.8%). The mean age of the patients was 56.3±13.2 years. Clinical and anatomical analysis of material from 19 deceased patients was carried out. Depending on the use of methods of renal replacement therapy, patients were divided into two groups: Group 1 included 23 patients with acute renal injury requiring the use of renal replacement therapy; Group 2 included 43 patients where methods of renal replacement therapy were not used.Results. Hospital mortality in Group 1 was lower (34.8 and 41.9%, respectively), however, the differences were statistically insignificant (p=0.372). To identify the factors in the development of acute renal damage, a stepwise regression analysis was performed by constructing a regression model of Cox proportional hazards. Age, history of chronic kidney disease, serum creatinine level on the first day after surgery, severity of the condition according to the APACHE-II scale, increased lactate level on day 2 of the postoperative period, decreased urine output on the first day after surgery were statistically significant.Conclusion. Risk factors for the development of ARI after cardiac surgery under cardiopulmonary bypass are advanced age, CKD in history, the severity of the patient’s condition, assessed by the APACHE-II scale, increased serum creatinine on the first day after surgery, increased lactate on day 2 of the postoperative period, a decreased diuresis on day 1 after surgery. The use of RRT in patients after surgery under the conditions of AC was accompanied by a tendency to improve treatment results: in-hospital mortality in the group of patients who underwent RRT was 34.8% versus 41.9% in the group without RRT methods. Morphological and functional features of renal failure in patients with ARI were preceding chronic renal pathological processes of different etiology, mainly affecting the glomeruli, vessels and stroma, as well as acute pathological processes aggravating ARI (dyscirculatory disorder, degenerative changes, necrosis and necrobiosis tubular epithelium).

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Incidence- and In-hospital Mortality-Related Risk Factors of Acute Kidney Injury Requiring Continuous Renal Replacement Therapy in Patients Undergoing Surgery for Acute Type a Aortic Dissection

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2021.749592 ◽

2021 ◽

Vol 8 ◽

Author(s):

Xuelian Chen ◽

Jiaojiao Zhou ◽

Miao Fang ◽

Jia Yang ◽

Xin Wang ◽

...

Keyword(s):

Risk Factors ◽

Renal Replacement Therapy ◽

Aortic Dissection ◽

Hospital Mortality ◽

Continuous Renal Replacement Therapy ◽

Replacement Therapy ◽

Type A ◽

Acute Type ◽

Type A Aortic Dissection ◽

Independent Risk Factors

Background: Few studies on the risk factors for postoperative continuous renal replacement therapy (CRRT) in a homogeneous population of patients with acute type A aortic dissection (AAAD). This retrospective analysis aimed to investigate the risk factors for CRRT and in-hospital mortality in the patients undergoing AAAD surgery and to discuss the perioperative comorbidities and short-term outcomes.Methods: The study collected electronic medical records and laboratory data from 432 patients undergoing surgery for AAAD between March 2009 and June 2021. All the patients were divided into CRRT and non-CRRT groups; those in the CRRT group were divided into the survivor and non-survivor groups. The univariable and multivariable analyses were used to identify the independent risk factors for CRRT and in-hospital mortality.Results: The proportion of requiring CRRT and in-hospital mortality in the patients with CRRT was 14.6 and 46.0%, respectively. Baseline serum creatinine (SCr) [odds ratio (OR), 1.006], cystatin C (OR, 1.438), lung infection (OR, 2.292), second thoracotomy (OR, 5.185), diabetes mellitus (OR, 6.868), AKI stage 2–3 (OR, 22.901) were the independent risk factors for receiving CRRT. In-hospital mortality in the CRRT group (46%) was 4.6 times higher than in the non-CRRT group (10%). In the non-survivor (n = 29) and survivor (n = 34) groups, New York Heart Association (NYHA) class III-IV (OR, 10.272, P = 0.019), lactic acidosis (OR, 10.224, P = 0.019) were the independent risk factors for in-hospital mortality in patients receiving CRRT.Conclusion: There was a high rate of CRRT requirement and high in-hospital mortality after AAAD surgery. The risk factors for CRRT and in-hospital mortality in the patients undergoing AAAD surgery were determined to help identify the high-risk patients and make appropriate clinical decisions. Further randomized controlled studies are urgently needed to establish the risk factors for CRRT and in-hospital mortality.

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Outcomes of COVID-19 patients intubated after failure of non-invasive ventilation: a multicenter observational study

Scientific Reports ◽

10.1038/s41598-021-96762-1 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Annalisa Boscolo ◽

Laura Pasin ◽

Nicolò Sella ◽

Chiara Pretto ◽

Martina Tocco ◽

...

Keyword(s):

Risk Factors ◽

Hospital Mortality ◽

Endotracheal Intubation ◽

Invasive Ventilation ◽

Icu Patients ◽

Multicenter Observational Study ◽

Icu Admission ◽

Non Invasive ◽

Non Invasive Ventilation ◽

Potential Risk Factors

AbstractThe efficacy of non-invasive ventilation (NIV) in acute respiratory failure secondary to SARS-CoV-2 infection remains controversial. Current literature mainly examined efficacy, safety and potential predictors of NIV failure provided out of the intensive care unit (ICU). On the contrary, the outcomes of ICU patients, intubated after NIV failure, remain to be explored. The aims of the present study are: (1) investigating in-hospital mortality in coronavirus disease 2019 (COVID-19) ICU patients receiving endotracheal intubation after NIV failure and (2) assessing whether the length of NIV application affects patient survival. This observational multicenter study included all consecutive COVID-19 adult patients, admitted into the twenty-five ICUs of the COVID-19 VENETO ICU network (February–April 2020), who underwent endotracheal intubation after NIV failure. Among the 704 patients admitted to ICU during the study period, 280 (40%) presented the inclusion criteria and were enrolled. The median age was 69 [60–76] years; 219 patients (78%) were male. In-hospital mortality was 43%. Only the length of NIV application before ICU admission (OR 2.03 (95% CI 1.06–4.98), p = 0.03) and age (OR 1.18 (95% CI 1.04–1.33), p < 0.01) were identified as independent risk factors of in-hospital mortality; whilst the length of NIV after ICU admission did not affect patient outcome. In-hospital mortality of ICU patients intubated after NIV failure was 43%. Days on NIV before ICU admission and age were assessed to be potential risk factors of greater in-hospital mortality.

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Outcomes of COVID-19 Patients Intubated After Failure of Non-Invasive Ventilation: A Multicenter Observational Study.

10.21203/rs.3.rs-400059/v1 ◽

2021 ◽

Author(s):

Annalisa Boscolo ◽

Laura Pasin ◽

Nicolò Sella ◽

Chiara Pretto ◽

Martina Tocco ◽

...

Keyword(s):

Risk Factors ◽

Hospital Mortality ◽

Endotracheal Intubation ◽

Invasive Ventilation ◽

Icu Patients ◽

Multicenter Observational Study ◽

Icu Admission ◽

Non Invasive ◽

Non Invasive Ventilation ◽

Potential Risk Factors

Abstract IntroductionThe efficacy of non-invasive ventilation (NIV) in acute respiratory failure secondary to SARS-CoV-2 infection remains controversial. Current literature mainly examined efficacy, safety and potential predictors of NIV failure provided out of the Intensive Care Unit (ICU). On the contrary, the outcomes of ICU patients, intubated after NIV failure, remain to be explored. The aims of the present study are: 1) investigating in-hospital mortality in coronavirus disease 2019 (COVID-19) ICU patients receiving endotracheal intubation after NIV failure and 2) assessing whether the length of NIV application affects patient survival. MethodsThis observational multicenter study included all consecutive COVID-19 adult patients, admitted into the twenty-five ICUs of the COVID-19 VENETO ICU network (February-April 2020), who underwent endotracheal intubation after NIV failure. ResultsAmong the 704 patients admitted to ICU during the study period, 280 (40%) presented the inclusion criteria and were enrolled. The median age was 69 [60-76] years; 219 patients (78%) were male. In-hospital mortality was 43%. Only the length of NIV application before ICU admission (OR 2.03 (95% CI 1.06 - 4.98), p = 0.03) and age (OR 1.18 (95% CI 1.04 - 1.33), p < 0.01) were identified as independent risk factors of in-hospital mortality; whilst the length of NIV after ICU admission did not affect patient outcome. ConclusionsIn-hospital mortality of ICU patients intubated after NIV failure was 43%. Days on NIV before ICU admission and age were assessed to be potential risk factors of greater in-hospital mortality.

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Intra-dialytic hypotension following the transition from continuous to intermittent renal replacement therapy

Annals of Intensive Care ◽

10.1186/s13613-021-00885-7 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

William Beaubien-Souligny ◽

Yifan Yang ◽

Karen E. A. Burns ◽

Jan O. Friedrich ◽

Alejandro Meraz-Muñoz ◽

...

Keyword(s):

Renal Replacement Therapy ◽

Hospital Mortality ◽

Replacement Therapy ◽

Kidney Injury ◽

Hemodynamic Instability ◽

Factors Associated ◽

Definition Of ◽

Vasopressor Use ◽

Cumulative Fluid Balance ◽

Intermittent Renal Replacement Therapy

Abstract Background Transition from continuous renal replacement therapy (CRRT) to intermittent renal replacement therapy (IRRT) can be associated with intra-dialytic hypotension (IDH) although data to inform the definition of IDH, its incidence and clinical implications, are lacking. We aimed to describe the incidence and factors associated with IDH during the first IRRT session following transition from CRRT and its association with hospital mortality. This was a retrospective single-center cohort study in patients with acute kidney injury for whom at least one CRRT-to-IRRT transition occurred while in intensive care. We assessed associations between multiple candidate definitions of IDH and hospital mortality. We then evaluated the factors associated with IDH. Results We evaluated 231 CRRT-to-IRRT transitions in 213 critically ill patients with AKI. Hospital mortality was 43.7% (n = 93). We defined IDH during the first IRRT session as 1) discontinuation of IRRT for hemodynamic instability; 2) any initiation or increase in vasopressor/inotropic agents or 3) a nadir systolic blood pressure of < 90 mmHg. IDH during the first IRRT session occurred in 50.2% of CRRT-to-IRRT transitions and was independently associated with hospital mortality (adjusted odds ratio [OR]: 2.71; CI 1.51–4.84, p < 0.001). Clinical variables at the time of CRRT discontinuation associated with IDH included vasopressor use, higher cumulative fluid balance, and lower urine output. Conclusions IDH events during CRRT-to-IRRT transition occurred in nearly half of patients and were independently associated with hospital mortality. We identified several characteristics that anticipate the development of IDH following the initiation of IRRT.

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