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Effect of end-stage renal disease on long-term survival after a first-ever mechanical ventilation: a population-based study.

Chen CM, Lai CC, Cheng KC, Weng SF, Liu WL, Shen HN - Crit Care (2015)

Bottom Line: ESRD(Pos) patients (n = 1185; mean age: 65.9 years; men: 51.5 %) were individually matched to ESRD(Neg) patients (ratio: 1:8) using a propensity score method.The primary outcome was death after a 1-MV.The baseline characteristics of the two cohorts were balanced, but the incidence of mortality was higher in ESRD(Pos) patients than in ESRD(Neg) patients (342.30 versus 179.67 per 1000 person-years; P <0.001; covariate-adjusted hazard ratio: 1.43; 95 % confidence interval: 1.31-1.51).

View Article: PubMed Central - PubMed

Affiliation: Department of Recreation and Health-Care Management, Chia Nan University of Pharmacy and Science, No.60, Sec. 1, Erren Road., Rende District, Tainan, 71710, Taiwan. chencm3383@yahoo.com.tw.

ABSTRACT

Introduction: Patients with end-stage renal disease (ESRD(Pos)) usually have multiple comorbidities and are predisposed to acute organ failure and in-hospital mortality. We assessed the effect of ESRD on the poorly understood long-term mortality risk after a first-ever mechanical ventilation (1-MV) for acute respiratory failure.

Methods: The data source was Taiwan's National Health Insurance (NHI) Research Database. All patients given a 1-MV between 1999 and 2008 from one million randomly selected NHI beneficiaries were identified (n = 38,659). Patients with or without ESRD (ESRD(Neg)) after a 1-MV between 1999 and 2008 were retrospectively compared and followed from the index admission date to death or the end of 2011. ESRD(Pos) patients (n = 1185; mean age: 65.9 years; men: 51.5 %) were individually matched to ESRD(Neg) patients (ratio: 1:8) using a propensity score method. The primary outcome was death after a 1-MV. The effect of ESRD on the risk of death after MV was assessed. A Cox proportional hazard regression model was used to assess how ESRD affected the mortality risk after a 1-MV.

Results: The baseline characteristics of the two cohorts were balanced, but the incidence of mortality was higher in ESRD(Pos) patients than in ESRD(Neg) patients (342.30 versus 179.67 per 1000 person-years; P <0.001; covariate-adjusted hazard ratio: 1.43; 95 % confidence interval: 1.31-1.51). For patients who survived until discharge, ESRD was not associated with long-term (>4 years) mortality.

Conclusions: ESRD increased the mortality risk after a 1-MV, but long-term survival seemed similar.

No MeSH data available.


Related in: MedlinePlus

Kaplan-Meier survival curves of ESRDPos patients and ESRDNeg controls. ESRD end stage renal disease
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Fig1: Kaplan-Meier survival curves of ESRDPos patients and ESRDNeg controls. ESRD end stage renal disease

Mentions: ESRDPos patients after a 1-MV showed a precipitous decline in mortality early on, and a parallel course thereafter, which suggests that although the starting point is lower, the trajectory has not changed (Fig. 1). After 4 years, the survival curves seem to be almost parallel, which might indicate that ESRD increases short-term but not long-term mortality. Patients who were older, had more organ failures, and had been admitted to the Surgery Department had a significantly higher mortality (Fig. 2a–c), but there was no significant difference in the survival rate between males and females (Fig. 2d).Fig. 1


Effect of end-stage renal disease on long-term survival after a first-ever mechanical ventilation: a population-based study.

Chen CM, Lai CC, Cheng KC, Weng SF, Liu WL, Shen HN - Crit Care (2015)

Kaplan-Meier survival curves of ESRDPos patients and ESRDNeg controls. ESRD end stage renal disease
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4589902&req=5

Fig1: Kaplan-Meier survival curves of ESRDPos patients and ESRDNeg controls. ESRD end stage renal disease
Mentions: ESRDPos patients after a 1-MV showed a precipitous decline in mortality early on, and a parallel course thereafter, which suggests that although the starting point is lower, the trajectory has not changed (Fig. 1). After 4 years, the survival curves seem to be almost parallel, which might indicate that ESRD increases short-term but not long-term mortality. Patients who were older, had more organ failures, and had been admitted to the Surgery Department had a significantly higher mortality (Fig. 2a–c), but there was no significant difference in the survival rate between males and females (Fig. 2d).Fig. 1

Bottom Line: ESRD(Pos) patients (n = 1185; mean age: 65.9 years; men: 51.5 %) were individually matched to ESRD(Neg) patients (ratio: 1:8) using a propensity score method.The primary outcome was death after a 1-MV.The baseline characteristics of the two cohorts were balanced, but the incidence of mortality was higher in ESRD(Pos) patients than in ESRD(Neg) patients (342.30 versus 179.67 per 1000 person-years; P <0.001; covariate-adjusted hazard ratio: 1.43; 95 % confidence interval: 1.31-1.51).

View Article: PubMed Central - PubMed

Affiliation: Department of Recreation and Health-Care Management, Chia Nan University of Pharmacy and Science, No.60, Sec. 1, Erren Road., Rende District, Tainan, 71710, Taiwan. chencm3383@yahoo.com.tw.

ABSTRACT

Introduction: Patients with end-stage renal disease (ESRD(Pos)) usually have multiple comorbidities and are predisposed to acute organ failure and in-hospital mortality. We assessed the effect of ESRD on the poorly understood long-term mortality risk after a first-ever mechanical ventilation (1-MV) for acute respiratory failure.

Methods: The data source was Taiwan's National Health Insurance (NHI) Research Database. All patients given a 1-MV between 1999 and 2008 from one million randomly selected NHI beneficiaries were identified (n = 38,659). Patients with or without ESRD (ESRD(Neg)) after a 1-MV between 1999 and 2008 were retrospectively compared and followed from the index admission date to death or the end of 2011. ESRD(Pos) patients (n = 1185; mean age: 65.9 years; men: 51.5 %) were individually matched to ESRD(Neg) patients (ratio: 1:8) using a propensity score method. The primary outcome was death after a 1-MV. The effect of ESRD on the risk of death after MV was assessed. A Cox proportional hazard regression model was used to assess how ESRD affected the mortality risk after a 1-MV.

Results: The baseline characteristics of the two cohorts were balanced, but the incidence of mortality was higher in ESRD(Pos) patients than in ESRD(Neg) patients (342.30 versus 179.67 per 1000 person-years; P <0.001; covariate-adjusted hazard ratio: 1.43; 95 % confidence interval: 1.31-1.51). For patients who survived until discharge, ESRD was not associated with long-term (>4 years) mortality.

Conclusions: ESRD increased the mortality risk after a 1-MV, but long-term survival seemed similar.

No MeSH data available.


Related in: MedlinePlus