Key result
A predictive scoring model identified high-risk emergent hemodialysis patients with a 47.2% risk of in-hospital cardiac arrest within 3 days, compared to 18.3% in low-risk patients.
Why the study?
Patients undergoing hemodialysis are prone to cardiac arrests, motivating the development of a risk score to predict in-hospital cardiac arrest in emergency department patients receiving emergency hemodialysis.
Does a predictive scoring model accurately predict in-hospital cardiac arrest in emergent hemodialysis patients?
Observational (n=257)
Does a predictive scoring model accurately predict in-hospital cardiac arrest in emergent hemodialysis patients?
Absolute Event Rate: 47.2% vs 18.3%
A novel scoring system using potassium, pH, oxygen saturation, and mean arterial pressure can predict short-term in-hospital cardiac arrest in patients requiring emergent hemodialysis.
May aid IHCA risk stratification in emergent hemodialysis; hypothesis-generating pending prospective validation.
Background: Patients undergoing hemodialysis are prone to cardiac arrests. Methods: This study aimed to develop a risk score to predict in-hospital cardiac arrest (IHCA) in emergency department (ED) patients undergoing emergency hemodialysis. Patients were included if they received urgent hemodialysis within 24 h after ED arrival. The primary outcome was IHCA within three days. Predictors included three domains: comorbidity, triage information (vital signs), and initial biochemical results. The final model was generated from data collected between 2015 and 2018 and validated using data from 2019. Results: A total of 257 patients, including 52 with IHCA, were analyzed. Statistical analysis selected significant variables with higher sensitivity cutoff, and scores were assigned based on relative beta coefficient ratio: K > 5.5 mmol/L (score 1), pH < 7.35 (score 1), oxygen saturation < 85% (score 1), and mean arterial pressure < 80 mmHg (score 2). The final scoring system had an area under the curve of 0.78 (p < 0.001) in the primary group and 0.75 (p = 0.023) in the validation group. The high-risk group (defined as sum scores ≥ 3) had an IHCA risk of 47.2% and 41.7%, while the low-risk group (sum scores < 3) had 18.3% and 7%, in the primary and validation databases, respectively. Conclusions: This predictive score model for IHCA in emergent hemodialysis patients could help healthcare providers to take necessary precautions and allocate resources.
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Chen et al. (2021) conducted an observational in Emergent hemodialysis (n=257). High-risk score (≥ 3) vs. Low-risk score (< 3) was evaluated on In-hospital cardiac arrest (IHCA) within three days. A predictive scoring model identified high-risk emergent hemodialysis patients with a 47.2% risk of in-hospital cardiac arrest within 3 days, compared to 18.3% in low-risk patients.
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