Outcome of critically ill patients treated with intermittent high-volume haemofiltration: A prospective cohort analysis

H. M. Oudemans-Van Straaten, R. J. Bosman, J. I. Van Der Spoel, D. F. Zandstra

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Objective: To evaluate intervention and outcome in critically ill patients treated with high-volume haemofiltration (HV-HF). Design: Prospective cohort analysis. Setting. 18-bed closed format general intensive care unit (ICU) of a teaching hospital. Patients: 30-month cohort of ICU patients treated with HV-HF. Interventions: Intermittent high-volume venovenous haemofiltration. Endpoints: Observed and predicted mortality in prospectively stratified prognostic groups. Measurements and results: Clinical and filtration data, Acute Physiology and Chronic Health Evaluation (APACHE) II, Simplified Acute Physiology Score (SAPS) II and the Madrid Acute Renal Failure (ARF) score and predicted mortality. A total of 306 patients were haemofiltrated (140 medical, 166 surgical), 52% were oliguric. Mean APACHE II score was 31 (SD 8) and mean SAPS II score 60 (SD 16). Mean ultrafiltrate rate was 63 ml/min (SD 20). A median total of 160 litres (90% range 49 to 453) were filtrated per patient, material costs were 565 ECU (90% range 199 to 1514). ICU mortality was 33%, hospital mortality 40% [95% confidence interval (CI) 34 to 45], predicted mortality by the ARF score 67% (CI 66 to 69). Non-cardiac surgery mortality was 47% (CI 39 to 54), 73% (CT 70 to 76) predicted by APACHE II and 67% (CI 64 to 70) by SAPS II. Observed mortality was significantly lower than predicted in all prognostic groups. The standardised mortality ratio (SMR) was no higher than the SMR in the overall ICU population. Conclusions: Mortality in HV-HF patients was lower than that predicted by illness severity scores, as was the case in all patients in our ICU. Treatment with HV-HF appears to be safe and feasible. The efficacy of HV-HF should be tested in randomised, controlled trials of suitable power.

Original languageEnglish
Pages (from-to)814-821
Number of pages8
JournalIntensive Care Medicine
Volume25
Issue number8
DOIs
Publication statusPublished - 8 Sep 1999

Cite this

@article{07e357625f554eafa390466c9a375866,
title = "Outcome of critically ill patients treated with intermittent high-volume haemofiltration: A prospective cohort analysis",
abstract = "Objective: To evaluate intervention and outcome in critically ill patients treated with high-volume haemofiltration (HV-HF). Design: Prospective cohort analysis. Setting. 18-bed closed format general intensive care unit (ICU) of a teaching hospital. Patients: 30-month cohort of ICU patients treated with HV-HF. Interventions: Intermittent high-volume venovenous haemofiltration. Endpoints: Observed and predicted mortality in prospectively stratified prognostic groups. Measurements and results: Clinical and filtration data, Acute Physiology and Chronic Health Evaluation (APACHE) II, Simplified Acute Physiology Score (SAPS) II and the Madrid Acute Renal Failure (ARF) score and predicted mortality. A total of 306 patients were haemofiltrated (140 medical, 166 surgical), 52{\%} were oliguric. Mean APACHE II score was 31 (SD 8) and mean SAPS II score 60 (SD 16). Mean ultrafiltrate rate was 63 ml/min (SD 20). A median total of 160 litres (90{\%} range 49 to 453) were filtrated per patient, material costs were 565 ECU (90{\%} range 199 to 1514). ICU mortality was 33{\%}, hospital mortality 40{\%} [95{\%} confidence interval (CI) 34 to 45], predicted mortality by the ARF score 67{\%} (CI 66 to 69). Non-cardiac surgery mortality was 47{\%} (CI 39 to 54), 73{\%} (CT 70 to 76) predicted by APACHE II and 67{\%} (CI 64 to 70) by SAPS II. Observed mortality was significantly lower than predicted in all prognostic groups. The standardised mortality ratio (SMR) was no higher than the SMR in the overall ICU population. Conclusions: Mortality in HV-HF patients was lower than that predicted by illness severity scores, as was the case in all patients in our ICU. Treatment with HV-HF appears to be safe and feasible. The efficacy of HV-HF should be tested in randomised, controlled trials of suitable power.",
keywords = "Acute renal failure, Haemofiltration, Hospital mortality, Multiple organ failure, Outcome prediction, Severity of illness",
author = "{Oudemans-Van Straaten}, {H. M.} and Bosman, {R. J.} and {Van Der Spoel}, {J. I.} and Zandstra, {D. F.}",
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doi = "10.1007/s001340050957",
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Outcome of critically ill patients treated with intermittent high-volume haemofiltration : A prospective cohort analysis. / Oudemans-Van Straaten, H. M.; Bosman, R. J.; Van Der Spoel, J. I.; Zandstra, D. F.

In: Intensive Care Medicine, Vol. 25, No. 8, 08.09.1999, p. 814-821.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Outcome of critically ill patients treated with intermittent high-volume haemofiltration

T2 - A prospective cohort analysis

AU - Oudemans-Van Straaten, H. M.

AU - Bosman, R. J.

AU - Van Der Spoel, J. I.

AU - Zandstra, D. F.

PY - 1999/9/8

Y1 - 1999/9/8

N2 - Objective: To evaluate intervention and outcome in critically ill patients treated with high-volume haemofiltration (HV-HF). Design: Prospective cohort analysis. Setting. 18-bed closed format general intensive care unit (ICU) of a teaching hospital. Patients: 30-month cohort of ICU patients treated with HV-HF. Interventions: Intermittent high-volume venovenous haemofiltration. Endpoints: Observed and predicted mortality in prospectively stratified prognostic groups. Measurements and results: Clinical and filtration data, Acute Physiology and Chronic Health Evaluation (APACHE) II, Simplified Acute Physiology Score (SAPS) II and the Madrid Acute Renal Failure (ARF) score and predicted mortality. A total of 306 patients were haemofiltrated (140 medical, 166 surgical), 52% were oliguric. Mean APACHE II score was 31 (SD 8) and mean SAPS II score 60 (SD 16). Mean ultrafiltrate rate was 63 ml/min (SD 20). A median total of 160 litres (90% range 49 to 453) were filtrated per patient, material costs were 565 ECU (90% range 199 to 1514). ICU mortality was 33%, hospital mortality 40% [95% confidence interval (CI) 34 to 45], predicted mortality by the ARF score 67% (CI 66 to 69). Non-cardiac surgery mortality was 47% (CI 39 to 54), 73% (CT 70 to 76) predicted by APACHE II and 67% (CI 64 to 70) by SAPS II. Observed mortality was significantly lower than predicted in all prognostic groups. The standardised mortality ratio (SMR) was no higher than the SMR in the overall ICU population. Conclusions: Mortality in HV-HF patients was lower than that predicted by illness severity scores, as was the case in all patients in our ICU. Treatment with HV-HF appears to be safe and feasible. The efficacy of HV-HF should be tested in randomised, controlled trials of suitable power.

AB - Objective: To evaluate intervention and outcome in critically ill patients treated with high-volume haemofiltration (HV-HF). Design: Prospective cohort analysis. Setting. 18-bed closed format general intensive care unit (ICU) of a teaching hospital. Patients: 30-month cohort of ICU patients treated with HV-HF. Interventions: Intermittent high-volume venovenous haemofiltration. Endpoints: Observed and predicted mortality in prospectively stratified prognostic groups. Measurements and results: Clinical and filtration data, Acute Physiology and Chronic Health Evaluation (APACHE) II, Simplified Acute Physiology Score (SAPS) II and the Madrid Acute Renal Failure (ARF) score and predicted mortality. A total of 306 patients were haemofiltrated (140 medical, 166 surgical), 52% were oliguric. Mean APACHE II score was 31 (SD 8) and mean SAPS II score 60 (SD 16). Mean ultrafiltrate rate was 63 ml/min (SD 20). A median total of 160 litres (90% range 49 to 453) were filtrated per patient, material costs were 565 ECU (90% range 199 to 1514). ICU mortality was 33%, hospital mortality 40% [95% confidence interval (CI) 34 to 45], predicted mortality by the ARF score 67% (CI 66 to 69). Non-cardiac surgery mortality was 47% (CI 39 to 54), 73% (CT 70 to 76) predicted by APACHE II and 67% (CI 64 to 70) by SAPS II. Observed mortality was significantly lower than predicted in all prognostic groups. The standardised mortality ratio (SMR) was no higher than the SMR in the overall ICU population. Conclusions: Mortality in HV-HF patients was lower than that predicted by illness severity scores, as was the case in all patients in our ICU. Treatment with HV-HF appears to be safe and feasible. The efficacy of HV-HF should be tested in randomised, controlled trials of suitable power.

KW - Acute renal failure

KW - Haemofiltration

KW - Hospital mortality

KW - Multiple organ failure

KW - Outcome prediction

KW - Severity of illness

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U2 - 10.1007/s001340050957

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JO - Intensive Care Medicine

JF - Intensive Care Medicine

SN - 0342-4642

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