Acute renal failure in patients with sepsis in a surgical ICU- .ppt

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,Introduction,Etiology ARF: Numerous possible causes Often multifactorial M

2、ortality 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,Aims of the study,Epidemiology of ARF in SICU pati

3、ents with sepsis Predisposing factors leading to ARFImpact of ARF on outcome,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

4、Data till 14 days of septic episode Organ failure: whole ICU episode ARF: Cr 2 mg/dL,Results,185 patients included 30 patients (16.2 %) with ARF ARF: Sepsis day: 3 (1 - 5) 21 (70%) treated with RRT,Results: demographics,Results: Scoring systems,Non-ARF ARF,APACHE II,SOFA,Results: Clinical outcome,Re

5、sults: scoring systems, non-renal,Non-ARF ARF,APACHE II,SOFA,Results: Risk factors on day 1 of sepsis,Variables on day 1 of sepsis, associated with ARF,Stepwise forward logistic regression model (Wald),89.1 % of ARF episodes predicted P = 0.334 (Hosmer & Lemeshow),Results: Mortality and organ dysfun

6、ction,Results: Mortality and organ dysfunction,Stepwise forward logistic regression model (Wald),76 % correct prediction of mortality P = 0.875 (Hosmer-Lemeshow),Discussion,Occurence rate ARF = 16.4 % (70 % RRT)ARF = early organ failure ( 3 d), in contrast to data of the pastARF patients had more pr

7、onounced 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?,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”,