To analyze the clinical characteristics and prognostic factors of patients with end-stage renal disease (ESRD) complicated with sepsis in the intensive care unit (ICU).

A retrospective analysis was conducted on ICU patients with ESRD complicated with sepsis form 2008 to 2022 of the medical information mart for intensive care IV (MIMIC-IV, v3.0) database. Data on demographic characteristics, vital signs, laboratory indicators, comorbidities, hospital-based diagnostic and therapeutic procedures, disease severity scores, and endpoint indicators were collected. The patients were divided into the survival group and non-survival group based on their 30-day survival status after ICU admission. The clinical characteristics of the two groups of patients were compared, and a multi-factor logistic regression analysis was used to screen for risk factors affecting patient survival within one month after ICU admission. A regression model was constructed, and a receiver operating characteristic (ROC) curve was plotted to explore its predictive effect on prognosis.

A total of 1, 214 patients were included, and 318 died within one month after admission to the ICU, with a mortality rate of 26.2%. Compared to the survival group, patients in the non-survival group had significantly older age, higher heart and respiratory rates, lower mean arterial pressure, and elevated scores in the simplified acute physiology score Ⅱ (SAPS Ⅱ), sequential organ failure assessment (SOFA), and Oxford acute severity of illness score (OASIS) (all P<0.05). Multivariate logistic analysis revealed that older age, higher levels of red blood cell distribution width, lactic acid, Charlson comorbidity index, and SOFA score, as well as complication with cerebrovascular disease were independent risk factors for the patients mortality, while higher base excess and dialysis acted as protective factors. The prediction model achieved an area under the ROC curve of 0.79, with a sensitivity of 0.69 and a specificity of 0.76, significantly outperforming the predictive performance of SOFA, SAPS Ⅱ, or OASIS alone.

During the ICU stay of the patients with ESRD complicated with sepsis, clinicians should monitor changes in red cell distribution width, lactate, base excess, Charlson comorbidity index, and SOFA, ensure adequate dialysis, and actively prevent complications such as cerebrovascular disease.