Factors Affecting Continuous Renal Replacement Therapy (CRRT) in Patients With Septic Shock: An Analysis of a National Inpatient Sample Database.

Background: Septic shock is defined as sepsis with hypotension requiring vasopressors to maintain a mean arterial pressure above 65 mmHg and having a serum lactate level of more than 2 mmol/L despite adequate volume resuscitation as per the Sepsis-3 criteria. Continuous renal replacement therapy (CRRT) is commonly utilized in septic shock patients for the treatment of acute kidney injury as well as for modulating immune response and maintaining hemodynamic stability.

Methods: We looked at the National Inpatient Sample database in 2019. We identified adult patients with septic shock as the primary diagnosis using the International Classification of Diseases, 10th revision, clinical modification codes R65.21 and R78.81, and subbranches of Aa41, A40, and R60. STATA 18 (StataCorp, College Station, TX) was used to perform logistic multivariate regression analyses.

Results: A total of 15,794 adults who were admitted for septic shock as the primary diagnosis underwent CRRT. The mean age of the patients was 61.7 years. The overall mortality rate was 57% (N = 9,002). An increase in age by one year was associated with a 1% increase in mortality (p = 0.001). The presence of hypertension increased mortality by 29% (N = 6,391) (p = 0.028). Interestingly, preexisting diabetes mellitus improved mortality by 37% (N = 3331) (p = 0.001).The outcome of CRRT was better in patients with chronic kidney disease, with a 26% improvement in mortality (N = 2341) (p = 0.001). A significant improvement in outcome (29% decrease in mortality, p=0.013) and 31% reduction in hospital length of stay (p = 0.008) was noted with CRRT initiated on day 2 of hospitalization.

Conclusion: This study highlights that the approximate time of initiation of CRRT for optimal benefit of the treatment is between 24 and 48 hours of hospitalization. This study emphasizes the prognostic factors of a standard therapy, which can serve as a basis for clinical decision-making.