ESRD Increases Post-Op In-Hospital Mortality

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End-stage renal disease (ESRD) at the time of admission to a surgical intensive care unit (ICU) is independently associated with an increased risk of in-hospital death, according to researchers.

That conclusion is based on retrospective analysis of prospectively gathered data from 12,938 patients admitted to a 50-bed surgical ICU from January 2004 to January 2009. Of these, 199 (1.5%) had ESRD at admission. They had significantly higher ICU and hospital mortality rates compared with patients without ESRD (23.1% and 31.2% vs. 5.5% and 10.0%, respectively), Mareike Apel, MD, of Friedrich-Schiller-University Hospital in Jena, Germany, and colleagues reported online ahead of print in Critical Care.

At ICU admission, the ESRD patients had higher disease severity scores and a higher incidence of diabetes mellitus and cirrhosis than patients without ESRD. In addition, the ESRD patients had significantly higher rates of organ failure at ICU admission and during the ICU stay. For example, during the ICU stay, cardiovascular and hematologic failure occurred in 72.4% and 21.6% of the ESRD patients, respectively, compared with 49.2% and 4.5% of the patients without ESRD.  Hepatic failure occurred in 12.1% of the ESRD patients compared with 3.0% of the patients without ESRD. The ESRD patients also had a significantly more days in the ICU (median 2 vs. 1).

In multivariable analysis, ESRD was independently associated with a nearly fourfold increased risk of in-hospital death, after adjusting for age, gender, comorbidities, and other potential confounders.

“The poor outcome in ESRD patients is probably multifactorial,” the investigators explained. “These patients likely lack physiological reserve, as evident from the high severity of illness and the associated comorbid conditions on admission to the ICU.”

The authors concluded that their data can be useful in preoperative risk stratification.

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