Predictors of in-hospital mortality among patients with cirrhosis and renal replacement therapy in the ICU: a retrospective cohort study

BACKGROUND: Hospitalized patients with cirrhosis are at high risk for kidney failure and subsequent in-hospital mortality, but predictors of in-hospital mortality for patients that require acute renal replacement therapy (RRT) remains underexplored. METHODS: Retrospective, observational cohort study including patients ≥18 years of age with cirrhosis from any cause who were admitted to the ICU between March 2013 and May 2018 and started on RRT. The primary outcome was in-hospital mortality. Logistic regression was used to identify factors associated with poor outcomes and a decision tree analysis was performed to visualize characteristics associated in-hospital mortality. RESULTS: A total of 138 patients were included and 103 (75 %) died in the hospital. Factors associated with in-hospital mortality were lower temperature (odds ratio [OR] 0.349, 95 % Confidence Interval [CI] 0.131 to 0.928), increased heart rate (OR 1.094, 95 % CI 1.040 to 1.150), increased BUN-to-creatinine ratio (OR 1.206, 95 % CI 1.072 to 1.357), increased hemoglobin (OR 1.085, 95 % CI 1.030 to 1.144), decreased platelets (OR 0.988, 95 % CI 0.978 to 0.998), and increased total bilirubin (OR 1.006, 95 % CI 1.000 to 1.012). Decision tree analysis found that temperature, heart rate, MELD-Na, and platelet count were associated worse outcomes. CONCLUSIONS: Decreased temperature, increased heart rate, and decreased serum platelets were repeatedly associated with in-hospital mortality in patients with cirrhosis on acute RRT.