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논문분류	춘계학술대회 초록집
제목	Validation of prediction model for successful discontinuation of continuous renal replacement therapy
저자	Junseok Jeon, Hyun Chul Song, Hyejeong Park, Danbee Kang, Juhee Cho, Jung Eun Lee, Wooseong Huh, Yoon-Goo Kim, Dae Joong Kim, Hye Ryoun Jang
출판정보	2021; 2021(1):
키워드
초록	Objective: Temporal validation was performed using data from 540 critically ill patients with AKI who underwent CRRT for more than 2 days and survived for 7 or more days after CRRT discontinuation from 2018 to 2020 in Samsung Medical Center. Variables included in the model were urine output (≥ 300 mL/day, score 4) on the day before CRRT discontinuation and blood urea nitrogen (BUN < 35 mg/dL, score 2), serum potassium (< 4.1 mmol/L, score 1), and mean arterial blood pressure (50-78 mmHg, score 1) on the discontinuation day. Successful discontinuation of CRRT was defined as no RRT requirement for 7 days after CRRT discontinuation. Methods: Area under the curve of the receiver-operating characteristic (AUC-ROC) curve was 0.77 (95% CI 0.73-0.81). Low-, intermediate-, and high-score groups were comprised of patients with 0 - 2 points, 3 - 5 points, and 6 - 8 points, respectively. Differences between observed and predicted incidence rates were 3.9% (observed and predicted probability, 9.9% and 13.8%, respectively), 1.6% (32.1% and 30.5%), and 0.3% (71.7% and 72.0%) in the low-, intermediate-, and high-score groups, respectively. In the subgroups consisting of patient with cancer, cardiorenal syndrome, or others, the AUC-ROC were 0.75 (96% CI 0.66-0.82), 0.77 (0.69 – 0.84), and 0.78 (0.73-0.84), respectively. Results: Our prediction model for successful discontinuation of CRRT in critically ill patients performed well in temporal validation. Further research, including external validation using different regional or institutional population, to assess clinical utility is required. Conclusions: Objective: Continuous renal replacement therapy (CRRT) has become the standard modality of RRT in critically ill patients with acute kidney injury (AKI). However, there is no consensus criterion for discontinuing CRRT, and a predictive model of successful discontinuation of CRRT from our previous study was developed. We aimed to evaluate the usefulness of the prediction model using temporal validation. Methods: Temporal validation was performed using data from 540 critically ill patients with AKI who underwent CRRT for more than 2 days and survived for 7 or more days after CRRT discontinuation from 2018 to 2020 in Samsung Medical Center. Variables included in the model were urine output (≥ 300 mL/day, score 4) on the day before CRRT discontinuation and blood urea nitrogen (BUN < 35 mg/dL, score 2), serum potassium (< 4.1 mmol/L, score 1), and mean arterial blood pressure (50-78 mmHg, score 1) on the discontinuation day. Successful discontinuation of CRRT was defined as no RRT requirement for 7 days after CRRT discontinuation. Results: Area under the curve of the receiver-operating characteristic (AUC-ROC) curve was 0.77 (95% CI 0.73-0.81). Low-, intermediate-, and high-score groups were comprised of patients with 0 - 2 points, 3 - 5 points, and 6 - 8 points, respectively. Differences between observed and predicted incidence rates were 3.9% (observed and predicted probability, 9.9% and 13.8%, respectively), 1.6% (32.1% and 30.5%), and 0.3% (71.7% and 72.0%) in the low-, intermediate-, and high-score groups, respectively. In the subgroups consisting of patient with cancer, cardiorenal syndrome, or others, the AUC-ROC were 0.75 (96% CI 0.66-0.82), 0.77 (0.69 – 0.84), and 0.78 (0.73-0.84), respectively. Conclusions: Our prediction model for successful discontinuation of CRRT in critically ill patients performed well in temporal validation. Further research, including external validation using different regional or institutional population, to assess clinical utility is required.
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