Risk factors for death in chronic critical illness

Lokhandwala, Sharukh; Escobar, B; Chahin, Abdullah; McCague, Ned; Ghassemi, Marzyeh; Feng, Mengling; Celi, LA

doi:10.1186/2197-425x-3-s1-a449

Cited by 1 publication

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“…Instead, heart failure can serve as a surrogate for chronic cardiovascular disease. In a study of 17,478 patients who survived more than 30 days after ICU admission, the overall incidence of congestive heart failure was 25%, and was significantly greater (46%) among subjects who expired within the following year [ 7 ]. Subjects who expired within one year also had greater acute requirements for cardiovascular support, manifested as significantly longer duration of vasopressor use (median 1.5 days vs. 0.8 days).…”

Section: Definitions Epidemiology and Risk For Cardiovascular And Renal Disease In Chronic Critical Illnessmentioning

confidence: 99%

“…Similar to the observation that acute cardiovascular dysfunction during critical illness is associated with chronic cardiovascular disease and worse long-term outcomes, CCI appears to affect kidney injury trajectories adversely. Among subjects who survive more than 30 days after ICU admission, the overall incidence of ESRD was 1.1%, and was significantly greater (3.2%) among subjects who expired within one year [ 7 ]. Subjects who expired within one year also had greater incidence of AKI (18.3% vs. 6.3%), mimicking the acute and persistent chronic disease paradigm observed for cardiovascular disease.…”

Section: Definitions Epidemiology and Risk For Cardiovascular And Renal Disease In Chronic Critical Illnessmentioning

confidence: 99%

“…Unfortunately, many of these survivors suffer from chronic organ dysfunction and induced frailty, representing an emerging chronic critical illness (CCI) phenotype with poor long-term outcomes and increased healthcare resource use [ 5 , 6 ]. Persistent and worsening cardiovascular and renal disease are primary drivers of the CCI phenotype [ 7 , 8 ]. Cardiovascular and renal disease appear to have pathophysiologic synergy in which renal disease potentiates cardiovascular disease and cardiovascular disease potentiates renal disease, creating a cycle of worsening disease burden and clinical outcomes manifest as cardio-renal syndromes [ 9 , 10 , 11 , 12 , 13 ].…”

Section: Introductionmentioning

confidence: 99%

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Cardiovascular and Renal Disease in Chronic Critical Illness

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With advances in critical care, patients who would have succumbed in previous eras now survive through hospital discharge. Many survivors suffer from chronic organ dysfunction and induced frailty, representing an emerging chronic critical illness (CCI) phenotype. Persistent and worsening cardiovascular and renal disease are primary drivers of the CCI phenotype and have pathophysiologic synergy, potentiating one another and generating a downward spiral of worsening disease and clinical outcomes manifest as cardio-renal syndromes. In addition to pharmacologic therapies (e.g., diuretics, beta adrenergic receptor blockers, angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, and blood pressure control), special consideration should be given to behavioral modifications that avoid the pitfalls of polypharmacy and suboptimal renal and hepatic dosing, to which CCI patients may be particularly vulnerable. Smoking cessation, dietary modifications (e.g., early high-protein nutrition and late low-sodium diets), and increased physical activity are advised. Select patients benefit from cardiac re-synchronization therapy or renal replacement therapy. Coordinated, patient-centered care bundles may improve compliance with standards of care and patient outcomes. Given the complex, heterogeneous nature of cardiovascular and renal disease in CCI and the dismal long-term outcomes, further research is needed to clarify pathophysiologic mechanisms of cardio-renal syndromes in CCI and develop targeted therapies.

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Section: Definitions Epidemiology and Risk For Cardiovascular And Renal Disease In Chronic Critical Illnessmentioning

confidence: 99%

Section: Definitions Epidemiology and Risk For Cardiovascular And Renal Disease In Chronic Critical Illnessmentioning

confidence: 99%