Cargando…
Bedside prediction of intradialytic hemodynamic instability in critically ill patients: the SOCRATE study
BACKGROUND: Despite improvements in intermittent hemodialysis management, intradialytic hemodynamic instability (IHI) remains a common issue that could account for increased mortality and delayed renal recovery. However, predictive factors of IHI remain poorly explored. The objective of this study w...
Autores principales: | , , , , , , , , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer International Publishing
2020
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7176798/ https://www.ncbi.nlm.nih.gov/pubmed/32323060 http://dx.doi.org/10.1186/s13613-020-00663-x |
_version_ | 1783525074564808704 |
---|---|
author | Bigé, Naïke Lavillegrand, Jean-Rémi Dang, Julien Attias, Philippe Deryckere, Stéphanie Joffre, Jérémie Dubée, Vincent Preda, Gabriel Dumas, Guillaume Hariri, Geoffroy Pichereau, Claire Baudel, Jean-Luc Guidet, Bertrand Maury, Eric Boelle, Pierre-Yves Ait-Oufella, Hafid |
author_facet | Bigé, Naïke Lavillegrand, Jean-Rémi Dang, Julien Attias, Philippe Deryckere, Stéphanie Joffre, Jérémie Dubée, Vincent Preda, Gabriel Dumas, Guillaume Hariri, Geoffroy Pichereau, Claire Baudel, Jean-Luc Guidet, Bertrand Maury, Eric Boelle, Pierre-Yves Ait-Oufella, Hafid |
author_sort | Bigé, Naïke |
collection | PubMed |
description | BACKGROUND: Despite improvements in intermittent hemodialysis management, intradialytic hemodynamic instability (IHI) remains a common issue that could account for increased mortality and delayed renal recovery. However, predictive factors of IHI remain poorly explored. The objective of this study was to evaluate the relationship between baseline macrohemodynamic, tissue hypoperfusion parameters and IHI occurrence. METHODS: Prospective observational study conducted in a 18-bed medical ICU of a tertiary teaching hospital. Cardiovascular SOFA score, index capillary refill time (CRT) and lactate level were measured just before (T0) consecutive intermittent hemodialysis sessions performed for AKI. The occurrence of IHI requiring a therapeutic intervention was recorded. RESULTS: Two hundred eleven sessions, corresponding to 72 (34%) first sessions and 139 (66%) later sessions, were included. As IHI mostly occurred during first sessions (43% vs 12%, P < 0.0001), following analyses were performed on the 72 first sessions. At T0, cardiovascular SOFA score ≥1 (87% vs 51%, P = 0.0021) was more frequent before IHI sessions, as well as index CRT ≥ 3 s (55% vs 15%, P = 0.0004), and hyperlactatemia > 2 mmol/L (68% vs 29%, P = 0.0018). Moreover, the occurrence of IHI increased with the number of macrohemodynamic and tissue perfusion impaired parameters, named SOCRATE score (cardiovascular SOFA, index CRT and lactATE): 10% (95% CI [3%, 30%]), 33% (95% CI [15%, 58%]), 55% (95% CI [35%, 73%]) and 80% (95% CI [55%, 93%]) for 0, 1, 2 and 3 parameters, respectively (AUC = 0.79 [0.69–0.89], P < 0.0001). These results were confirmed by analyzing the 139 later sessions included in the study. CONCLUSIONS: The SOCRATE score based on 3 easy-to-use bedside parameters correlates with the risk of IHI. By improving risk stratification of IHI, this score could help clinicians to manage intermittent hemodialysis initiation in critically ill AKI patients. |
format | Online Article Text |
id | pubmed-7176798 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Springer International Publishing |
record_format | MEDLINE/PubMed |
spelling | pubmed-71767982020-04-28 Bedside prediction of intradialytic hemodynamic instability in critically ill patients: the SOCRATE study Bigé, Naïke Lavillegrand, Jean-Rémi Dang, Julien Attias, Philippe Deryckere, Stéphanie Joffre, Jérémie Dubée, Vincent Preda, Gabriel Dumas, Guillaume Hariri, Geoffroy Pichereau, Claire Baudel, Jean-Luc Guidet, Bertrand Maury, Eric Boelle, Pierre-Yves Ait-Oufella, Hafid Ann Intensive Care Research BACKGROUND: Despite improvements in intermittent hemodialysis management, intradialytic hemodynamic instability (IHI) remains a common issue that could account for increased mortality and delayed renal recovery. However, predictive factors of IHI remain poorly explored. The objective of this study was to evaluate the relationship between baseline macrohemodynamic, tissue hypoperfusion parameters and IHI occurrence. METHODS: Prospective observational study conducted in a 18-bed medical ICU of a tertiary teaching hospital. Cardiovascular SOFA score, index capillary refill time (CRT) and lactate level were measured just before (T0) consecutive intermittent hemodialysis sessions performed for AKI. The occurrence of IHI requiring a therapeutic intervention was recorded. RESULTS: Two hundred eleven sessions, corresponding to 72 (34%) first sessions and 139 (66%) later sessions, were included. As IHI mostly occurred during first sessions (43% vs 12%, P < 0.0001), following analyses were performed on the 72 first sessions. At T0, cardiovascular SOFA score ≥1 (87% vs 51%, P = 0.0021) was more frequent before IHI sessions, as well as index CRT ≥ 3 s (55% vs 15%, P = 0.0004), and hyperlactatemia > 2 mmol/L (68% vs 29%, P = 0.0018). Moreover, the occurrence of IHI increased with the number of macrohemodynamic and tissue perfusion impaired parameters, named SOCRATE score (cardiovascular SOFA, index CRT and lactATE): 10% (95% CI [3%, 30%]), 33% (95% CI [15%, 58%]), 55% (95% CI [35%, 73%]) and 80% (95% CI [55%, 93%]) for 0, 1, 2 and 3 parameters, respectively (AUC = 0.79 [0.69–0.89], P < 0.0001). These results were confirmed by analyzing the 139 later sessions included in the study. CONCLUSIONS: The SOCRATE score based on 3 easy-to-use bedside parameters correlates with the risk of IHI. By improving risk stratification of IHI, this score could help clinicians to manage intermittent hemodialysis initiation in critically ill AKI patients. Springer International Publishing 2020-04-22 /pmc/articles/PMC7176798/ /pubmed/32323060 http://dx.doi.org/10.1186/s13613-020-00663-x Text en © The Author(s) 2020 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. |
spellingShingle | Research Bigé, Naïke Lavillegrand, Jean-Rémi Dang, Julien Attias, Philippe Deryckere, Stéphanie Joffre, Jérémie Dubée, Vincent Preda, Gabriel Dumas, Guillaume Hariri, Geoffroy Pichereau, Claire Baudel, Jean-Luc Guidet, Bertrand Maury, Eric Boelle, Pierre-Yves Ait-Oufella, Hafid Bedside prediction of intradialytic hemodynamic instability in critically ill patients: the SOCRATE study |
title | Bedside prediction of intradialytic hemodynamic instability in critically ill patients: the SOCRATE study |
title_full | Bedside prediction of intradialytic hemodynamic instability in critically ill patients: the SOCRATE study |
title_fullStr | Bedside prediction of intradialytic hemodynamic instability in critically ill patients: the SOCRATE study |
title_full_unstemmed | Bedside prediction of intradialytic hemodynamic instability in critically ill patients: the SOCRATE study |
title_short | Bedside prediction of intradialytic hemodynamic instability in critically ill patients: the SOCRATE study |
title_sort | bedside prediction of intradialytic hemodynamic instability in critically ill patients: the socrate study |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7176798/ https://www.ncbi.nlm.nih.gov/pubmed/32323060 http://dx.doi.org/10.1186/s13613-020-00663-x |
work_keys_str_mv | AT bigenaike bedsidepredictionofintradialytichemodynamicinstabilityincriticallyillpatientsthesocratestudy AT lavillegrandjeanremi bedsidepredictionofintradialytichemodynamicinstabilityincriticallyillpatientsthesocratestudy AT dangjulien bedsidepredictionofintradialytichemodynamicinstabilityincriticallyillpatientsthesocratestudy AT attiasphilippe bedsidepredictionofintradialytichemodynamicinstabilityincriticallyillpatientsthesocratestudy AT deryckerestephanie bedsidepredictionofintradialytichemodynamicinstabilityincriticallyillpatientsthesocratestudy AT joffrejeremie bedsidepredictionofintradialytichemodynamicinstabilityincriticallyillpatientsthesocratestudy AT dubeevincent bedsidepredictionofintradialytichemodynamicinstabilityincriticallyillpatientsthesocratestudy AT predagabriel bedsidepredictionofintradialytichemodynamicinstabilityincriticallyillpatientsthesocratestudy AT dumasguillaume bedsidepredictionofintradialytichemodynamicinstabilityincriticallyillpatientsthesocratestudy AT haririgeoffroy bedsidepredictionofintradialytichemodynamicinstabilityincriticallyillpatientsthesocratestudy AT pichereauclaire bedsidepredictionofintradialytichemodynamicinstabilityincriticallyillpatientsthesocratestudy AT baudeljeanluc bedsidepredictionofintradialytichemodynamicinstabilityincriticallyillpatientsthesocratestudy AT guidetbertrand bedsidepredictionofintradialytichemodynamicinstabilityincriticallyillpatientsthesocratestudy AT mauryeric bedsidepredictionofintradialytichemodynamicinstabilityincriticallyillpatientsthesocratestudy AT boellepierreyves bedsidepredictionofintradialytichemodynamicinstabilityincriticallyillpatientsthesocratestudy AT aitoufellahafid bedsidepredictionofintradialytichemodynamicinstabilityincriticallyillpatientsthesocratestudy |