Correlation Of CRRT Treatment Timing With Clinical Outcomes In Patients With Severe Acute Heart Failure

Objective:To investigate the efficacy of CRRT in the treatment of acute heart failure and its correlation analysis between the time of starting treatment and patient death.Methods:234 patients with acute heart failure admitted to CCU and treated with CRRT from January 2018 to May 2022 in our hospital were collected as study subjects.（1）According to the time of CRRT initiation,patients could be divided into 132 cases in the early treatment group（≤24h）and 102 cases in the late treatment group（>24h）;and patients were divided into survival and non-survival groups according to whether they survived the score at discharge and whether they survived the 60-day follow-up after discharge.The general clinical data,various examination results before and after the last CRRT treatment,vital sign parameters,total time of CRRT treatment,number of times,total ultrafiltration,occurrence of complications during treatment,total hospitalization time,time of CCU stay and patients’survival and readmission at 30 and 60 days after discharge were collected from the two groups,respectively,and the above data were statistically analyzed,to explore the impact with patient clinical outcomes.Results:（1）Comparison of efficacy and effectiveness:The results of this study showed that the total effective rate of treatment was higher in the early group than in the late group[98.5%vs93.1%,P<0.05];RR,HR,SBP,DBP,LVEF,NT-Pro BNP,K⁺,Na⁺,HCO₃^-,PH,Pa CO₂,Sa O₂,Lac,CRP,PCT,and BUN were significantly better in both groups after each treatment,Cr,UA,and BUN were significantly better than before treatment（P<0.05）,and the elevated LVEF,NT-Pro BNP,CRP,PCT,Cr,UA,and BUN were lower in the early group than in the late group（P<0.05）;The recovery rate of renal function was higher in the early group than in the late group,[66.7%vs.53.9%,P<0.05];（2）Complication rates during treatment were significantly lower in the early treatment group than in the late treatment group（P<0.05）,including pulmonary edema[5.3%vs 12.7%,χ2=4.077,P<0.05],cardiac arrest[1.5%vs 6.9%,χ2=4.449,P<0.05],and systemic inflammatory response syndrome[2.3%vs 8.8%,χ2=5.011,P<0.05].The duration of hospitalization was significantly shorter in the early group than in the late group in both groups,[14（9,21）vs16.5（12,24）,P<0.05];the total cost of hospitalization was slightly lower in the early group than in the late group in both groups,but there was no difference,[77681.7（54403.6,129884.5）vs.93688.8（57578.6,14730.7）,P>0.05];The cost of inpatient CCU treatment was lower in the early group compared with the late group in both groups,[14237.6（8006.3,23762.4）vs.20671.1（14358.2,39661.9）,P<0.05];The total time and number of CRRT performed in both groups was significantly reduced in the early group compared with the late group,[46.0（32.0,74.2）h,5（3,8）times vs49.5（39.0,88.0）h,6（4,8）times,P<0.05];there was no difference in the in-hospital mortality rate between the two groups,[19.7%vs 24.5%,P>0.05];（3）In-hospital mortality affecting patients Analysis of risk factors:binary logistic regression analysis of this study showed that patients’age（OR=1.071,P=0.000,95%CI 1.036-1.107）,pretreatment DBP（OR=0.958,P=0.020,95%CI 0.923-0.993）,Lac（OR=1.155,P=0.019.95%CI 1.024-1.303）,duration of mechanical ventilation during hospitalization（OR=1.016,P=0.018,95%CI 1.003-1.030）,and renal injury（OR=2.501,P=0.027,95%CI 1.110-5.634）were independent risk factors for fatal events;initiation of CRRT treatment after 24 h had no significant effect on patients in-hospital death may not have a significant effect,（OR=0.698,P=0.259,95%CI 0.375-1.302）;（4）60-day follow-up results:this study showed 23 and 32 patients died within 30 d after discharge in the late and early groups,respectively,with mortality rates of 30.7%and 30.8%,respectively,comparing the two groups,（x²=0.000,P=0.998）;17 and 11 patients were readmitted within 30 d in the late group and early group,respectively,and the readmission rates were 22.7%and10.6%,respectively,（x²=4.827,P=0.028）.The number of patients who died within 60 d after discharge was 40 and 40 in the late group and early group,respectively,with mortality rates of 53.3%and 38.5%,respectively,（x²=3.899,P=0.048）;26 and 21 patients were readmitted within 60 d in the late group and early group,respectively,with readmission rates of 34.7%and 20.2%,respectively,（x²=4.715.P=0.030）;（5）Analysis of risk factors affecting patients’60-day mortality events:binary logistic regression analysis in this study showed that initiation of CRRT treatment after 24 h（OR=3.510,P=0.003,95%CI 1.551-7.943）,patient age（OR=1.040,P=0.013,95%CI 1.008-1.073）,pre-discharge DBP（OR=0.975,P=0.026,95%CI 0.953-0.997）,Lg NT-Pro BNP（OR=2.680,P=0.014,95%CI 1.224-5.868）,duration of mechanical ventilation during hospitalization（OR=1.035,P=0.005,95%CI 1.011-1.060）were risk factors for patient death;（6）Kaplan-meier survival analysis:30-day survival analysis showed no significant difference in 30-day mortality between the two groups（Log Rank x²=0.069,P=0.793）;60-day survival analysis showed that mortality in the early group was lower than that in the late group,and 60-day survival in the early group was better than that in the late group.The60-day survival analysis showed that the early group had a lower mortality rate than the late group,and the early group had a better 60-day survival than the late group（Log Rank x²=9.704,P=0.002）.Conclusion:Early initiation of CRRT may significantly reduce heart failure-related clinical symptoms and volume overload in patients with acute heart failure,including stabilization of the internal environment,improved recovery of renal function,more effective elevation of EF,lower NT-Pro BNP,and improved cardiac function;shorten the length of hospital stay and reduce hospital costs to some extent,and effectively reduce complications during treatment,30-and 60-day readmission rates,and60-day mortality.The timing of CRRT initiation is associated with 60-day mortality in critically ill patients,and early treatment may improve short-term survival.