Development of a predictive score for hypothermia risk during continuous kidney replacement therapy in critically ill...

Backgroud: Hypothermia is a frequent adverse event during continuous kidney replacement therapy (CKRT) and is associated with clinically relevant complications. However, evidence regarding its predictors remains limited. We aimed to develop a clinical prediction score to facilitate early risk stratification and targeted preventive management.

Methods: We conducted a retrospective cohort study of critically ill adults receiving CKRT in the Medical Intensive Care Unit, Faculty of Medicine, Chiang Mai University, Thailand, between February 2018 and August 2024. Hypothermia was defined as body temperature <35 °C occurring within 48 h after CKRT initiation. Multivariable logistic regression was utilized to identify independent predictors, and a prediction score was derived from the regression coefficients.

Results: Among 214 cases (mean age 65 years; 38.3% female), hypothermia occurred in 51.9% (n = 111 cases). Independent predictors included respiratory failure at ICU admission (+13 points), total bilirubin (+1 point per mg/dL), APACHE-II score (+1.5 points per APACHE-II point), pre-CKRT serum creatinine (- 2 points per mg/dL), and pre-CKRT body temperature (-1 point per 0.1 °C). The score exhibited good discriminative ability (C-statistic 0.78; 95% CI 0.71-0.83). A cutoff value of 20.0 yielded a sensitivity of 78% (95% CI 70-86), specificity of 62% (95% CI 52-72), positive likelihood ratio of 2.07 (95% CI 1.59-2.70) and negative likelihood ratio of 0.35 (95% CI 0.24-0.51).

Conclusion: Hypothermia is common during CKRT, and the proposed score may enable practical risk stratification and early identification of patients who could benefit from targeted preventive strategies.