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E Hoste, N Lameire, R Vanholder, D Benoit, J Decruyenaere, F Colardyn.

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

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E Hoste, N Lameire, R Vanholder, D Benoit, J Decruyenaere, F Colardyn.

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  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”

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