Survival and predictors of in-hospital mortality among critically ill patients on extracorporeal membrane oxygenation therapy and renal replacement therapy: a single-center, retrospective study
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Abstract
Background: Acute kidney injury (AKI) is one the most frequent complications among critically ill patients, especially patients with severe cardiopulmonary dysfunction during extracorporeal membrane oxygenation (ECMO) therapy. Fluid overload, electrolyte and metabolic disturbance are the consequences of AKI. Those with AKI and those requiring renal replacement therapy (RRT) are at high risk for mortality. Although RRT is the standard of care for AKI, the optimal time of RRT initiation remains controversial.
Methods: In a single center, retrospective study, we enrolled patients over 6 years. Patients were received during ECMO at Prince of Songklanagarind Hospital. We assigned patients to a before or after RRT group regarding the initiation time of ECMO. The primary outcome was in-hospital mortality.
Results: A total of 40 patients showed no significance among group differences in characteristics at baseline except GFR-EPI, pH, lactate level and SOFA score. Among the 40 patients, 76.9% in the RRT initiation before ECMO group and 88.9% in the RRT initiation after ECMO group died (P=0.321). Multivariable adjustment cox regression for in-hospital mortality showed that hazard ratio of RRT initiation before ECMO group was 0.067 (0.01-0.457), age ≥60 years was 6.334 (1.268-31.625), APACHE II score was 1.093 (1.007-1.187) and eGFR-EPI ≥60 mL/min/1.73m2 was 0.970 (0.946-0.996).
Conclusions: Among patients with ECMO and RRT, no difference was found in patients’ mortality between 2 groups but a significant, protective effect was observed on mortality between patients assigned to the RRT initiation before ECMO group. Factors associated with increased mortality were age 60 or more and APACHE II score. The factor associated with decreased mortality was eGFR-EPI ≥60 mL/min/1.73 m2.
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