Outcome of critically ill patients treated with intermittent high-volume haemofiltration: a prospective cohort analysis.
OBJECTIVE
To evaluate intervention and outcome in critically ill patients treated with high-volume haemofiltration (HV-HF).


METHODS
Prospective cohort analysis.


METHODS
18-bed closed format general intensive care unit (ICU) of a teaching hospital.


METHODS
30-month cohort of ICU patients treated with HV-HF.


METHODS
Intermittent high-volume venovenous haemofiltration.


METHODS
Observed and predicted mortality in prospectively stratified prognostic groups.


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 % (CI 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.
Oudemans-van Straaten
H M
HM
Department of Intensive Care, Onze Lieve Vrouwe Gasthuis, P. O. Box 95500, 1090 HM Amsterdam, The Netherlands. h.m.oudemans-vanstraaten@olvg.nl
Bosman
R J
RJ
van der Spoel
J I
JI
Zandstra
D F
DF
D018806:APACHE; D058186:Acute Kidney Injury / Q000401:mortality / Q000628:therapy*; D000368:Aged; D015331:Cohort Studies; D016638:Critical Illness / Q000401:mortality / Q000628:therapy*; D005260:Female; D006440:Hemofiltration / Q000379:methods; D006801:Humans; D008297:Male; D009102:Multiple Organ Failure / Q000401:mortality / Q000628:therapy*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D016896:Treatment Outcome