1 / 15

Acute Renal Failure in Sepsis Patients in Surgical ICU: Predictive Factors & Outcome

This study investigates incidence, comorbidity, and predictive factors of acute renal failure (ARF) in surgical ICU patients with sepsis. Results show high mortality rates and the significance of early intervention for improved outcomes.

sarai
Download Presentation

Acute Renal Failure in Sepsis Patients in Surgical ICU: Predictive Factors & Outcome

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Acute renal failure in patients with sepsis in a surgical ICU: Predictive factors,Incidence, Comorbidity, and Outcome E Hoste, N Lameire, R Vanholder, D Benoit, J Decruyenaere, F Colardyn. J Am Soc Nephrol 14: 1022-1030, 2003

  2. Introduction Etiology ARF: • Numerous possible causes • Often multifactorial Mortality ARF: 28 to 83 % • Differences in patient population? • E.g. young trauma patient vs old patient with CHF The ‘my study is important’ statement: • death toll sepsis = AMI (USA) • 35-50 % ARF cases is sepsis related • No data on risk factors ARF in sepsis

  3. Aims of the study • Epidemiology of ARF in SICU patients with sepsis • Predisposing factors leading to ARF • Impact of ARF on outcome

  4. M & M Study population: • 22 bed SICU • 16 mo study period • Sepsis (ACCP/SCCM consensus conference) • Excluded: chronic renal insufficiency (Cr> 1.5) treated elsewhere before Data collection: • Retrospective cohort • Electronic database • Data till 14 days of septic episode • Organ failure: whole ICU episode • ARF: Cr ≥ 2 mg/dL

  5. Results • 185 patients included • 30 patients (16.2 %) with ARF • ARF: • Sepsis day: 3 (1 - 5) • 21 (70%) treated with RRT

  6. Results: demographics

  7. Results: Scoring systems SOFA APACHE II • Non-ARF  ARF

  8. Results: Clinical outcome

  9. Results: scoring systems, non-renal APACHE II SOFA • Non-ARF  ARF

  10. Results: Risk factors on day 1 of sepsis

  11. Variables on day 1 of sepsis, associated with ARF Stepwise forwardlogistic regression model (Wald) 89.1 % of ARF episodes predicted P = 0.334 (Hosmer & Lemeshow)

  12. Results: Mortality and organ dysfunction

  13. Results: Mortality and organ dysfunction Stepwise forward logistic regression model (Wald) 76 % correct prediction of mortality P = 0.875 (Hosmer-Lemeshow)

  14. Discussion • Occurence rate ARF = 16.4 % (70 % RRT) • ARF = early organ failure (< 3 d), in contrast to data of the past • ARF patients had more pronounced capillary leak on day 1 (lower MAP, higher CVP, and more positive volume balance) We were too late  early goal directed therapy • Volume repletion alone is not sufficient  activated Protein C?

  15. Discussion • ARF patients more sick on admission and day 1 of sepsis (APACHE II/SOFA), and higher mortality, however, non-renal organ failure the same. • RRT was independent risk factor for mortality. “Patients do not die with ARF; they die because of ARF”

More Related