^{ 1}Division of Intensive Care, Department of Nursing, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
^{ 2}Division of Intensive Care, Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
© 2024 The Korean Society of Critical Care Medicine
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
^{} CONFLICT OF INTEREST
No potential conflict of interest relevant to this article was reported.
^{} FUNDING
This study was supported by a grant from the Siriraj Research Development Fund (managed by the Routine to Research Project), Faculty of Medicine Siriraj Hospital, Mahidol University.
^{} AUTHOR CONTRIBUTIONS
Conceptualization: TP, TN. Methodology: TP, TN. Formal analysis: TP. Data curation: TP, NK, PP, SA, HK. Visualization: TP, TN. Project administration: TP. Funding acquisition: TP. Writing - original draft: TP, TN. Writing - review & editing: TP, TN. All authors read and agreed to the published version of the manuscript.
^{} Values are presented as median (interquartile range) or number (%).
CRRT: continuous renal replacement therapy; APACHE: Acute Physiology and Chronic Health Evaluation; RRT: renal replacement therapy; ICU: intensive care unit; MAKE30: Major Adverse Kidney Event at day 30.
^{a)} Defined by time-weighted average temperature more than or equal 36 °C;
^{b)} Defined by time-weighted average temperature less than 36 °C;
^{c)} Norepinephrine equivalent dose=dose of norepinephrine (μg/kg/min)+dose of adrenaline (μg/kg/min)+(dopamine (μg/kg/min)/150).
^{} Values are presented as median (interquartile range) or number (%).
CRRT: continuous renal replacement therapy; BUN: blood urea nitrogen; CVVH: continuous venovenous hemofiltration; CVVHDF: continuous venovenous hemodiafiltration; SCUF: sustain continuous ultrafiltration.
^{a)} Defined by time-weighted average temperature more than or equal 36 °C;
^{b)} Defined by time-weighted average temperature less than 36 °C.
^{} Values are presented as mean±standard deviation.
ICU: intensive care unit; TWA: time-weighted average; TWA^{Temp}: TWA temperature was calculated as the area under the temperature-versus-time plot; Maximum^{Temp}: maximum temperature in the period of 24 hours of CRRT; Minimum^{Temp}: minimum temperature in the period of 24 hours of CRRT; CV: coefficient of variation; CV^{Temp}: standard deviation of the temperature divided by the mean temperature in the period of 24 hours of CRRT; T-max^{Temp}: time spent on the maximum temperature in the period of 24 hours of CRRT; T-min^{Temp}: time spent on the minimum temperature in the period of 24 hours of CRRT; Amplitude^{Temp}: difference between the maximum and the mean temperature in the period of 24 hours of CRRT; CRRT: continuous renal replacement therapy.
^{} Values are presented mean±standard deviation. Temperature was expressed as degree Celsius. Each model was adjusted with factors including age, body weight, fluid balance before continuous renal replacement therapy, dose of continuous renal replacement therapy.
ICU: intensive care unit; TWA: time-weighted average; TWA^{Temp}: TWA temperature was calculated as the area under the temperature-versus-time plot; Maximum^{Temp}: maximum temperature in the period of 24 hours of CRRT; Minimum^{Temp}: minimum temperature in the period of 24 hours of CRRT; CV: coefficient of variation; CV^{Temp}: standard deviation of the temperature divided by the mean temperature in the period of 24 hours of CRRT; T-max^{Temp}: time spent on the maximum temperature in the period of 24 hours of CRRT; T-min^{Temp}: time spent on the minimum temperature in the period of 24 hours of CRRT; Amplitude^{Temp}: difference between the maximum and the mean temperature in the period of 24 hours of CRRT; CRRT: continuous renal replacement therapy.
^{a)} Since multicollinearity is expected among the indices of TWA^{Temp}, each one was included alone and one at a time in the models, resulting in a total of six models;
^{b)} Odds ratio calculated per 1-hour increase.
Variable | Non-hypothermia^{a)} (n=229, 76.3%) | Hypothermia^{b)} (n=71, 23.7%) | P-value |
---|---|---|---|
Age (yr) | 66 (53–79) | 74 (61–81) | 0.02 |
Female | 95 (41.5) | 29 (40.8) | 0.99 |
Body weight (kg) | 61.8 (54.0–70.9) | 58.0 (50.0–65.0) | 0.03 |
APACHE II score | 24.0 (20.0–29.0) | 26.0 (22.0–31.5) | 0.01 |
Comorbidity | |||
Diabetes | 98 (42.8) | 31 43.7) | 0.99 |
Hypertension | 144 (62.9) | 42 (59.2) | 0.67 |
Chronic kidney disease | 133 (58.1) | 37 (52.1) | 0.45 |
Stage 3 | 44 (19.2) | 14 (19.7) | |
Stage 4 | 29 (12.7) | 7 (9.9) | |
Stage 5 | 59 (25.8) | 16 (22.5) | |
Coronary artery disease | 87 (38.0) | 26 (36.6) | 0.95 |
Congestive heart failure | 41 (17.9) | 11 (15.5) | 0.77 |
Liver disease | 39 (17.0) | 7 (9.9) | 0.20 |
Malignancy | 47 (20.5) | 15 (21.1) | 0.99 |
Indication for RRT | |||
Metabolic acidosis | 101 (44.1) | 45 (63.4) | 0.01 |
Fluid overload | 92 (40.2) | 27 (38.0) | 0.85 |
Hyperkalemia | 25 (10.9) | 7 (9.9) | 0.97 |
Sepsis | 129 (56.3) | 49 (69.0) | 0.08 |
Vasopressor | 184 (80.3) | 60 (84.5) | 0.54 |
Norepinephrine equivalent dose^{c)} (μg/kg/min) | 0.2 (0.1–0.5) | 0.3 (0.2–0.5) | 0.20 |
Mechanical ventilator | 201 (87.8) | 68 (95.8) | 0.09 |
Baseline temperature before CRRT (°C) | 36.9 (36.5–37.6) | 36.8 (36.4–37.5) | 0.34 |
External warmer | 21 (9.2) | 3 (4.2) | 0.28 |
ICU mortality | 101 (44.1) | 42 (59.2) | 0.04 |
Hospital mortality | 134 (58.5) | 51 (71.8) | 0.06 |
Renal outcome: MAKE30 | 154 (67.2) | 54 (76.1) | 0.21 |
Mortality at day 30 | 101 (44.1) | 46 (64.8) | 0.004 |
Doubling serum creatinine | 8 (10.7) | 3 (15.8) | 0.82 |
RRT dependence | 45 (37.2) | 5 (20.8) | 0.19 |
Variable | Non-hypothermia^{a)} (n=229, 76.3%) | Hypothermia^{b)} (n=71, 23.7%) | P-value |
---|---|---|---|
Hemoglobin (g/dl) | 8.8 (7.9–10.1) | 9.4 (8.2–10.6) | 0.12 |
BUN (mg/dl) | 66.0 (41.0–90.0) | 59.0 (38.0–83.5) | 0.16 |
Creatinine (mg/dl) | 3.6 (2.4–5.4) | 4.0 (2.7–5.5) | 0.26 |
Fluid balance day before CRRT (mL) | 1,421 (67–3,216) | 1,943 (1,254–4,390) | 0.01 |
Fluid balance on the day of CRRT (mL) | 744 (–1,926 to 2,767) | 1,850 (–1,071 to 4,758) | 0.04 |
CRRT modality | 0.25 | ||
CVVH | 210 (91.7) | 66 (93.0) | |
CVVHDF | 4 (1.7) | 3 (4.2) | |
SCUF | 15 (6.6) | 2 (2.8) | |
Blood flow rate (ml/min) | 200 (150–200) | 200 (150–200) | 0.08 |
Duration of CRRT (hr) | 19.5 (10.5–24.0) | 21.1 (11.3–24.0) | 0.52 |
Dose of CRRT (ml/kg/hr) | 30.9 (24.9–35.9) | 33.4 (29.0–38.7) | 0.01 |
CRRT dose > 30 ml/kg/hr | 120 (52.4) | 50 (70.4) | 0.01 |
Ultrafiltration (ml/day) | 420 (0–1,790) | 475 (0–1,401) | 0.69 |
Ultrafiltration (ml/kg/hr) | 0.4 (0.0–1.6) | 0.5 (0.0–1.5) | 0.92 |
Temperature setting of CRRT (°C) | 37.0 (37.0–38.0) | 37.5 (37.0–38.0) | 0.04 |
Number of temperature observations | 7.0 (5.0–11.0) | 8.0 (5.0–11.0) | 0.42 |
Variable | Univariable model |
Multivariable model^{a)} |
||
---|---|---|---|---|
Odds ratio (95% CI) | P-value | Odds ratio (95% CI) | P-value | |
Age (yr) | 1.02 (1.00–1.03) | 0.005 | 1.02 (1.00–1.04) | 0.05 |
Age >70 yr | 2.04 (1.19–3.54) | 0.01 | 2.59 (1.38–4.98) | 0.004 |
Body weight (kg) | 0.97 (0.95–0.99) | 0.01 | 0.89 (0.81–0.97) | 0.01 |
Metabolic acidosis^{b)} | 2.19 (1.28–3.84) | 0.005 | 1.56 (0.80–3.08) | 0.20 |
Fluid balance on the day before CRRT (L) | 1.12 (1.03–1.23) | 0.01 | 1.11 (1.02–1.22) | 0.02 |
Fluid balance on the day of CRRT (L) | 1.10 (1.03–1.17) | 0.007 | 1.10 (1.00–1.21) | 0.05 |
Dose of CRRT (ml/kg/hr) | 1.04 (1.01–1.06) | 0.01 | 1.003 (1.00–1.01) | 0.04 |
Temperature of CRRT (°C) | 1.12 (0.91–1.37) | 0.27 | - | - |
Variable | Survivor (n=157) | Non-survivor (n=143) | Absolute differenc (95% CI) | P-value |
---|---|---|---|---|
TWA^{Temp}°C) | 36.42±0.56 | 36.27±0.76 | 0.16 (0.003 to 0.31) | 0.04 |
Maximum^{Temp}°C) | 37.36±0.72 | 37.46±0.94 | –0.10 (–0.29 to 0.09) | 0.30 |
Minimum^{Temp}°C) | 35.68±0.82 | 35.34±1.10 | 0.34 (0.12 to 0.56) | 0.002 |
CV^{Temp}°C) | 1.56±0.90 | 2.09±1.47 | –0.53 (–0.81 to -0.25) | <0.001 |
T-max^{Temp}°C) | 6.43±7.57 | 4.32±6.75 | 2.11 (0.48 to 3.74) | 0.01 |
T-min^{Temp}°C) | 10.35±6.36 | 10.33±6.48 | 0.02 (–1.44 to 1.48) | 0.98 |
Amplitude^{Temp}°C) | 0.90±0.65 | 1.11±0.83 | –0.22 (–0.39 to –0.05) | 0.01 |
Temperature indices | Univariable models |
Multivariable models^{a)} |
||
---|---|---|---|---|
Odds ratio^{b)} (95% CI) | P-value | Odds ratio^{b)} (95% CI) | P-value | |
TWA^{Temp} | 0.70 (0.47–0.99) | 0.05 | 0.85 (0.57–1.25) | 0.41 |
Maximum^{Temp} | 1.16 (0.88–1.53) | 0.30 | 1.18 (0.88–1.58) | 0.27 |
Minimum^{Temp} | 0.69 (0.53–0.88) | 0.003 | 0.76 (0.57–1.00) | 0.05 |
CV^{Temp} | 1.46 (1.19–1.82) | < 0.001 | 1.41 (1.13–1.78) | 0.003 |
T-max^{Temp} | 0.96 (0.93–0.99) | 0.01 | 0.97 0.93–1.00) | 0.05 |
T-min^{Temp} | 1.00 (0.97–1.04) | 0.98 | 1.00 (0.96–1.04) | 0.99 |
Amplitude^{Temp} | 1.49 (1.09–2.06) | 0.01 | 1.32 (0.94–1.88) | 0.12 |
Values are presented as median (interquartile range) or number (%).
CRRT: continuous renal replacement therapy; APACHE: Acute Physiology and Chronic Health Evaluation; RRT: renal replacement therapy; ICU: intensive care unit; MAKE30: Major Adverse Kidney Event at day 30.
Defined by time-weighted average temperature more than or equal 36 °C;
Defined by time-weighted average temperature less than 36 °C;
Norepinephrine equivalent dose=dose of norepinephrine (μg/kg/min)+dose of adrenaline (μg/kg/min)+(dopamine (μg/kg/min)/150).
Values are presented as median (interquartile range) or number (%).
CRRT: continuous renal replacement therapy; BUN: blood urea nitrogen; CVVH: continuous venovenous hemofiltration; CVVHDF: continuous venovenous hemodiafiltration; SCUF: sustain continuous ultrafiltration.
Defined by time-weighted average temperature more than or equal 36 °C;
Defined by time-weighted average temperature less than 36 °C.
CRRT: continuous renal replacement therapy.
Multivariable models were performed by significant factors on univariable models;
Defined as blood pH less than 7.3.
Values are presented as mean±standard deviation.
ICU: intensive care unit; TWA: time-weighted average; TWA^{Temp}: TWA temperature was calculated as the area under the temperature-versus-time plot; Maximum^{Temp}: maximum temperature in the period of 24 hours of CRRT; Minimum^{Temp}: minimum temperature in the period of 24 hours of CRRT; CV: coefficient of variation; CV^{Temp}: standard deviation of the temperature divided by the mean temperature in the period of 24 hours of CRRT; T-max^{Temp}: time spent on the maximum temperature in the period of 24 hours of CRRT; T-min^{Temp}: time spent on the minimum temperature in the period of 24 hours of CRRT; Amplitude^{Temp}: difference between the maximum and the mean temperature in the period of 24 hours of CRRT; CRRT: continuous renal replacement therapy.
Values are presented mean±standard deviation. Temperature was expressed as degree Celsius. Each model was adjusted with factors including age, body weight, fluid balance before continuous renal replacement therapy, dose of continuous renal replacement therapy.
ICU: intensive care unit; TWA: time-weighted average; TWA^{Temp}: TWA temperature was calculated as the area under the temperature-versus-time plot; Maximum^{Temp}: maximum temperature in the period of 24 hours of CRRT; Minimum^{Temp}: minimum temperature in the period of 24 hours of CRRT; CV: coefficient of variation; CV^{Temp}: standard deviation of the temperature divided by the mean temperature in the period of 24 hours of CRRT; T-max^{Temp}: time spent on the maximum temperature in the period of 24 hours of CRRT; T-min^{Temp}: time spent on the minimum temperature in the period of 24 hours of CRRT; Amplitude^{Temp}: difference between the maximum and the mean temperature in the period of 24 hours of CRRT; CRRT: continuous renal replacement therapy.
Since multicollinearity is expected among the indices of TWA^{Temp}, each one was included alone and one at a time in the models, resulting in a total of six models;
Odds ratio calculated per 1-hour increase.