Short- and Long-Term Outcome of Chronic Dialyzed Patients Admitted to the ICU and Assessment of Prognosis Factors

Remi Trusson (1) , Vincent Brunot (2) , R. Larcher (3, 2) , Laura Platon (2) , Noémie Besnard (2) , Olivier Moranne (4, 1, 5) , Saber Barbar (1) , Jean-Emmanuel Serre (2) , Kada Klouche (2, 3)

1 CHU Nîmes - Centre Hospitalier Universitaire de Nîmes
2 CHRU Montpellier - Centre Hospitalier Régional Universitaire [Montpellier]
3 PhyMedExp - Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046]
4 CHU Nice - Centre Hospitalier Universitaire de Nice
5 AIDMP - Aide à la Décision pour une Médecine Personnalisé - Laboratoire de Biostatistique, Epidémiologie et Recherche Clinique - EA 2415

Objectives: Data about end-stage kidney disease patients admitted to the ICU are scarce, dated, and mostly limited to short-term survival. The aim of this study was to assess the short- and long-term outcome and to determine the prognostic factors for end-stage kidney disease patients admitted to the ICU. Design: Prospective observational study. Setting: Medical ICUs in two university hospitals. Patients: Consecutive end-stage kidney disease patients admitted in two ICUs between 2012 and 2017. Intervention: None. Measurements and Main Results: Renal replacement therapy variables, demographic, clinical, and biological data were collected. The requirement of mechanical ventilation and vasopressive drugs were also collected. In-ICU and one-year mortality were estimated and all data were analyzed in order to identify predictive factors of short and long-term mortality. A total of 140 patients were included, representing 1.7% of total admissions over the study period. Septic shock was the main reason for admission mostly of pulmonary origin. Median Simplified Acute Physiology Score II and Sequential Organ Failure Assessment score were at 63 and 6.7, respectively. In-ICU, hospital, and 1-year mortality were 41.4%, 46.4%, and 63%, respectively. ICU mortality was significantly higher as compared with ICU control group non-end-stage kidney disease (25% vs 41.4%; p = 0.005). By multivariate analysis, the short-term outcome was significantly associated with nonrenal Sequential Organ Failure Assessment score, and with the requirement of mechanical ventilation or/and vasoconstrictive agents during ICU stay. One-year mortality was associated with increased dialysis duration (> 3 yr) and phosphatemia (> 2.5 mmol/L), with lower albuminemia (< 30 g/L) and nonrenal Sequential Organ Failure Assessment greater than 8. Conclusions: End-stage kidney disease patients presented frequently severe complications requiring critical care that induced significant short- and long-term mortality. ICU and hospital mortality depended mainly on the severity of the critical event reflected by Sequential Organ Failure Assessment score and the need of mechanical ventilation and/or catecholamines. One-year mortality was associated with both albuminemia and phosphatemia and with prior duration of chronic dialysis treatment, and with organ failure at ICU admission.

Mots clés: chronic dialysis; chronic renal disease; end-stage renal disease; intensive care unit; outcome; prognosis

Domaines: Urologie et Néphrologie; Santé publique et épidémiologie

Remi Trusson, Vincent Brunot, R. Larcher, Laura Platon, Noémie Besnard, et al.. Short- and Long-Term Outcome of Chronic Dialyzed Patients Admitted to the ICU and Assessment of Prognosis Factors. Critical Care Medicine, 2020, 48 (8), pp.e666-e674. ⟨10.1097/CCM.0000000000004412⟩. ⟨hal-02864549⟩