Mortality-related risk factors associated with continuous renal replacement therapy in critically ill patients with hematologic disorders: A retrospective cohort study

Abstract Background：Continuous renal replacement therapy (CRRT) is increasingly employed for critically-ill patients with hematologic disorders. However, prognostic factors for CRRT outcomes in these patients remain unknown. This study aimed to identify mortality-related risk factors and explore potential interventions for critically ill patients with hematologic disorders receiving CRRT. Methods：This study included critically-ill patients with hematologic disorders who received CRRT at our center from November 1, 2023 to August 31, 2024. Univariate and multivariate logistic analyses were used to identify independent predictors for 90-day mortality and extracorporeal circuit thrombosis. Results：In this cohort of 90 critically-ill patients with hematologic disorders who received CRRT, the 90-day mortality reached 55.56% (50/90). Multivariable analysis demonstrated four independent mortality predictors: elevated APACHE II scores (OR=1.829, 95%CI=1.696-1.987, P=0.036), shorter CRRT duration per session (OR=1.070, 95%CI=1.004-1.141, P=0.038), prolonged hospitalization (OR=1.079, 95%CI=1.008-1.155, P=0.028), and circuit thrombosis occurrence (OR=5.977, 95%CI=1.013-35.259, P=0.048). Notably, 68.89% (67/90) patients developed CRRT-related circuit thrombosis, which was significantly associated with suboptimal citrate anticoagulation (infusion rate ≤2 mmol/L: OR=0.017, 95%CI=0.002-0.529, P=0.017), elevated post-filter ionized calcium (>0.35 mmol/L: OR=3.339, 95%CI=1.007-6.357, P=0.030), and paradoxical protective effects of higher ultrafiltration rates (>150 mL/h: OR=0.985, 95%CI=0.973-0.997, P=0.014). Additional risk factors included lower lactate levels (OR=0.721, 95%CI=0.562-0.926, P=0.010), thrombocytosis (platelet >100×10⁹/L: OR=1.961, 95%CI=1.921-2.940, P=0.036), and prolonged APTT (>40s: OR=1.243, 95%CI=1.052-1.470, P=0.011). Conclusion:CRRT circuit survival is critical for the mortality of hematologic patients who need CRRT, which depends on precise anticoagulation control (citrate-calcium balance) and individualized fluid management.