Nghiên cứu kết quả điều trị kết hợp của phương pháp siêu lọc máu ở bệnh nhân suy tim cấp và suy tim rất nặng

Abstract

Objective: To evaluate clinical outcomes and identify prognostic factors associated with 30-day mortality in patients with acute and advanced heart failure undergoing CRRT. Subject and method: A descriptive cross-sectional study with longitudinal follow-up was conducted on 60 patients with acute and advanced heart failure indicated for CRRT at the Cardiovascular Intensive Care Unit, Heart Institute, 108 Military Central Hospital, from May 2023 to December 2024. Data on clinical characteristics, laboratory parameters, CRRT details, and 30-day outcomes were collected and analyzed. Result: The mean age was 69.1 ± 13.9 years, with 65% male. Cardiogenic shock was present in 33.4% of patients, and oliguria or anuria in 45%. After 24 hours of CRRT, several laboratory indices showed significant improvement: Glucose decreased from 10.81 ± 6.46 to 7.22 ± 2.62mmol/L; urea decreased from 18.38 ± 9.46 to 12.46 ± 5.87mmol/L; creatinine decreased from 274.75 ± 161.03 to 186.67 ± 80.45µmol/L; lactate decreased from 6.55 ± 5.74 to 3.77 ± 2.70mmol/L; and pH increased from 7.27 ± 0.13 to 7.39 ± 0.05 (all p<0.05). The 30-day mortality rate was 25% (15/60 patients). Among clinical and laboratory variables, only pre-CRRT high-sensitivity C-reactive protein (hs-CRP) and lactate levels were significantly associated with mortality, with markedly higher levels in the non-survivor group compared to survivors (140.33 ± 83.80 vs. 48.98 ± 47.53mg/dL; 6.55 ± 5.74 vs. 4.86 ± 3.2mmol/L, p<0.05). Conclusion: CRRT can improve early biochemical parameters in patients with acute and advanced heart failure. Elevated pre-CRRT plasma hs-CRP and lactate levels may serve as valuable prognostic indicators of mortality in this patient population.