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...

Descripción completa

Detalles Bibliográficos
Autores principales: 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
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