Risk Factors for Mortality in Patients with Severe Acute Kidney Injury Treated with CRRT: A Single-Center Retrospective Study.

INTRODUCTION: To explore the risk factors of in-hospital death in patients with severe acute kidney injury (AKI) after continuous renal replacement therapy (CRRT) and to build a prediction model. METHODS: In total, 378 patients with AKI were treated in the ICU of affiliated hospital of Fujian Medical University, Zhangzhou City, between June 2018 and August 2024. All patients received CRRT. According to prognosis, patients were divided into the survivor and mortality groups. The clinical data from both groups were compared. A nomogram prediction model was developed based on independent risk factors identified through multivariable logistic regression analysis. RESULTS: Overall, 195 patients (51.59%) died in the hospital. Compared with the Acute Physiology and Chronic Health Evaluation II (APACHE II), the mortality group had significantly higher Acute Physiologic Assessment and Chronic Health Evaluation (APACHE) II and Sequential Organ Failure Assessment (SOFA) scores, mechanical ventilation rates, lactic acid levels, SCr at baseline, the last recorded SCr before death or discharge, duration of anuria before CRRT, total duration of RRT, and ICU stay, while initial and final eGFR were significantly lower (all, P < .05). Multivariable logistic regression analysis showed that APACHE Ⅱ score, SOFA score, duration of anuria before CRRT, and total duration of RRT were independent risk factors for hospital death in AKI (P < .05), while initial higher eGFR was a protective factor (P < .05). The consistency index (C-index) of the nomogram model was 0.751 (95%CI: 0.683~0.819), and the AUC of the ROC curve was 0.738 (95%CI: 0.701~0.775), which had good discrimination. The evaluation results of the calibration curve and clinical decision curve suggested that the model was accurate and effective. CONCLUSION: The APACHE II score, SOFA score, anuria duration before CRRT, and total RRT time were independently associated with in-hospital mortality of AKI patients treated with CRRT. These findings demonstrate the severity markers of AKI; nevertheless, prospective validation will remain necessary.