Key result
Prediction model identifies sufficient filter lifespan during anticoagulation-free CRRT with an AUC of 0.82.
Why the study?
Anticoagulation-free CRRT yields heterogeneous filter lifespan and specific cutoff values for coagulation parameters to predict sufficient filter lifespan are undetermined.
Can a multivariable prediction model accurately predict sufficient filter lifespan (≥24 h) in patients undergoing anticoagulation-free CRRT?
Cohort (n=214)
Yes
Can a multivariable prediction model accurately predict sufficient filter lifespan (≥24 h) in patients undergoing anticoagulation-free CRRT?
Effect estimate: AUC 0.82 (95% CI 0.76-0.88)
A novel 13-variable prediction model can accurately identify patients likely to achieve a sufficient filter lifespan (≥24 h) during anticoagulation-free CRRT.
May help select patients likely to achieve ≥24 h filter life during anticoagulation-free CRRT; leaves open whether the model improves outcomes over coagulation parameters alone.
BACKGROUND: Anticoagulation-free continuous renal replacement therapy (CRRT) was recommended by the current clinical guideline for patients with increased bleeding risk and contraindications of citrate. Nevertheless, anticoagulation-free CRRT yielded heterogeneous filter lifespan. Furthermore, the specific cutoff values for traditional coagulation parameters to predict sufficient filter lifespan of anticoagulation-free CRRT have not yet been determined. The purpose of our present study was to develop and validate a model for predicting sufficient filter lifespan in anticoagulation-free CRRT patients. METHODS: Patients who underwent anticoagulation-free CRRT in our center between June 2013 and June 2019 were retrospectively included. The primary outcome was sufficient filter lifespan (≥24 h). Thirty-seven predictors were included for modeling based on their clinical significance and previous reports. The final model was developed by using multivariable logistic regression analysis and was validated in a separate external cohort. RESULTS: The development cohort included 170 patients. Sufficient filter lifespan was observed in 80 patients. Thirteen variables were independent predictors for sufficient filter lifespan by logistic regression: body temperature, mean arterial pressure, activated partial thromboplastin time, direct bilirubin, alkaline phosphatase, blood urea nitrogen, vasopressor use, body mass index, white blood cell, platelet count, D-dimer, uric acid, and pH. The area under the curve (AUC) of the stepwise model and internal validation model was 0.82 (95% confidence interval [CI] [0.76-0.88]) and 0.8 (95% CI [0.74-0.87]), respectively. The positive predictive value and the negative predictive value of the stepwise model were 0.77 and 0.79, respectively. The validation cohort included 44 eligible patients and the AUC of the external validation model was 0.82 (95% CI [0.69-0.96]). CONCLUSIONS: The use of a prediction model instead of an assessment based only on coagulation parameters could facilitate the identification of the patients with filter lifespan of ≥24 h when they accepted anticoagulation-free CRRT.
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Zhang et al. (2021) conducted a cohort in Patients requiring anticoagulation-free continuous renal replacement therapy (CRRT) (n=214). 13-variable clinical prediction model vs. Assessment based only on coagulation parameters was evaluated on Sufficient filter lifespan (≥24 h) (AUC 0.82, 95% CI 0.76-0.88). A 13-variable prediction model successfully identified patients with a sufficient filter lifespan (≥24 h) during anticoagulation-free CRRT, achieving an AUC of 0.82 (95% CI 0.76-0.88).
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