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Acute renal failure in the ICU: risk factors and outcome evaluated by the SOFA score
被引：0
作者：
A. de Mendonça
J.-L. Vincent
P. M. Suter
R. Moreno
N. M. Dearden
M. Antonelli
J. Takala
C. Sprung
F. Cantraine
机构：
[1] Department of Intensive Care,
[2] Erasme University Hospital,undefined
[3] Route de Lennik 808,undefined
[4] 1070 Brussels,undefined
[5] Belgium e-mail: jlvincen@ulb.ac.be Tel.: + 32-2-5 55 33 80 Fax: + 32-2-5 55 45 55,undefined
[6] Dept of Surgery Int. Care,undefined
[7] Hopital Cantonal Universitaire,undefined
[8] 24 rue Micheli- du-Crest,undefined
[9] 1211 Geneve 14,undefined
[10] Switzerland,undefined
[11] Dept of Intensive Care,undefined
[12] S. Antonio Capuchos Hospital,undefined
[13] Al. St. Antonio Capuchos,undefined
[14] 1150 Lisboa,undefined
[15] Portugal,undefined
[16] Dept of Anaesthesiology,undefined
[17] Leeds General Infirmary,undefined
[18] Great George Street,undefined
[19] Leeds LS1 3EX,undefined
[20] UK,undefined
[21] Dept of Anesthesiology and Intensive care,undefined
[22] Universita “La Sapienza”,undefined
[23] Policlinico Umberto I,undefined
[24] 00161 Roma,undefined
[25] Italy,undefined
[26] Dept of Intensive care,undefined
[27] University Hospital of Bern,undefined
[28] 3010 Bern,undefined
[29] Switzerland,undefined
[30] Dept of Anesthesiology,undefined
[31] Hadassah Univ. Med. Center,undefined
[32] 91120 Jerusalem,undefined
[33] Israel,undefined
[34] Faculty of Medicine,undefined
[35] Free University of Brussels,undefined
[36] Route de Lennik 808,undefined
[37] 1070 Brussels,undefined
[38] Belgium,undefined
来源：
Intensive Care Medicine
|
2000年
/
26卷
关键词：
Key words Mortality;
Oliguria;
Multiple organ failure;
Severity-of-illness;
Prognosis;
Scoring systems;
D O I：
暂无
中图分类号：
学科分类号：
摘要：
Objectives: To describe risk factors for the development of acute renal failure (ARF) in a population of intensive care unit (ICU) patients, and the association of ARF with multiple organ failure (MOF) and outcome using the sequential organ failure assessment (SOFA) score. Design: Prospective, multicenter, observational cohort analysis. Setting: Forty ICUs in 16 countries. Patients: All patients admitted to one of the participating ICUs in May 1995, except those who stayed in the ICU for less than 48 h after uncomplicated surgery, were included. After the exclusion of 38 patients with a history of chronic renal failure requiring renal replacement therapy, a total of 1411 patients were studied. Measurements and results: Of the patients, 348 (24.7 %) developed ARF, as diagnosed by a serum creatinine of 300 μmol/l (3.5 mg/dl) or more and/or a urine output of less than 500 ml/day. The most important risk factors for the development of ARF present on admission were acute circulatory or respiratory failure; age more than 65 years, presence of infection, past history of chronic heart failure (CHF), lymphoma or leukemia, or cirrhosis. ARF patients developed MOF earlier than non-ARF patients (median 24 vs 48 h after ICU admission, p < 0.05). ARF patients older than 65 years with a past history of CHF or with any organ failure on admission were most likely to develop MOF. ICU mortality was 3 times higher in ARF than in other patients (42.8 % vs 14.0 %, p < 0.01). Oliguric ARF was an independent risk factor for overall mortality as determined by a multivariate regression analysis (OR = 1.59 [CI 95 %: 1.23–2.06], p < 0.01). Infection increased the risk of death associated with all factors. Factors that increased the ICU mortality of ARF patients were a past history of hematologic malignancy, age more than 65 years, the number of failing organs on admission and the presence of acute cardiovascular failure. Conclusion: In ICU patients, the most important risk factors for ARF or mortality from ARF are often present on admission. During the ICU stay, other organ failures (especially cardiovascular) are important risk factors. Oliguric ARF was an independent risk factor for ICU mortality, and infection increased the contribution to mortality by other factors. The severity of circulatory shock was the most important factor influencing outcome in ARF patients.
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页码：915 / 921
页数：6
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