# Prognostic Factors of 30-Day In-Hospital Mortality in Critically Ill Patients Receiving Continuous Renal Replacement Therapy

## TL;DR

This study identifies factors that predict 30-day in-hospital mortality in critically ill patients undergoing kidney dialysis treatment called CRRT.

## Contribution

The study identifies specific prognostic factors for mortality in CRRT patients, including hepatic failure and changes in consciousness and sodium levels.

## Key findings

- Hepatic failure as a comorbidity significantly increases 30-day mortality risk in CRRT patients.
- Higher Sequential Organ Failure Assessment Scores and lower Glasgow Coma Scores are associated with increased mortality.
- Elevated sodium levels during CRRT are linked to higher in-hospital mortality.

## Abstract

Continuous renal replacement therapy (CRRT) is a form of dialysis that effectively replicates the excretory function of the kidneys in critically ill patients suffering from acute kidney injury. The number of patients receiving CRRT in critical care settings is increasing globally. Although these patients are at greater risk of mortality after commencing CRRT, the comprehensive risk factors for in-hospital mortality in this population remain uncertain.

The prognostic factors for 30-day in-hospital mortality in patients receiving CRRT are investigated in this study.

This retrospective observational study was performed at a tertiary care university hospital between January 2018 and December 2020. Data from a total of 613 patients requiring CRRT were included. Pre-, intra-, and post-CRRT data were extracted from electronic medical records, and patients were grouped based on 30-day in-hospital mortality into survivor (n = 300) and nonsurvivor (n = 313) groups.

The mortality rate within 30 days of hospitalization was 51.1%. The median survival time calculated using the Kaplan–Meier method was 9 days. The results of multivariate Cox regression analysis revealed hepatic failure as a comorbidity (adjusted hazard ratio [HR] = 2.75, 95% confidence interval [CI] = [1.15, 6.58]), post–continuous renal replacement therapy data including Glasgow Coma Score (adjusted HR = 0.82, 95% CI = [0.72, 0.94]), Sequential Organ Failure Assessment Score (adjusted HR = 1.16, 95% CI = [1.02, 1.32]), and sodium level (adjusted HR = 1.05, 95% CI =[1.01, 1.10]) to be linked to higher in 30-day in-hospital mortality for patients receiving CRRT.

Based on the findings, early detection and management of changes in illness severity, consciousness levels, and sodium levels during CRRT should be emphasized in ICU care settings. The authors hope the findings contribute to the design and application of transitional care plans for patients undergoing CRRT.