[Acute renal failure profile and prognostic value in severe acute pancreatitis].
BACKGROUND
Acute renal failure (ARF) complicating severe acute pancreatitis (SAP) carries a high mortality. Clinically useful scores to define patients who will develop this complication are lacking. We try to determine the incidence of ARF and variables predicting the appearance and severity of the episodes.


METHODS
Retrospective study of all SAP patients admitted in an intensive care unit between 1991 and 1998 (n = 154).


RESULTS
ARF incidence was 42%. Haemodynamic instability, APACHE II and Ranson score were related to ARF development. 62.2% of severe ARF patients had multiple organ failure (MOF). Mortality was 71.2% compared to 6.8% in patients without ARF (39.9% in mild ARF and 94.6% in severe ARF). Etiology relates to mortality (prerenal [46.4%], after severe hypotensive episode [71.4%], in MOF [93.3%]; p < 0.005). 63.6% patients required replacement therapy (hemofiltration [HF] 95.5%), with a mortality of 89.3% (100% for intermittent dialysis compared to 88% with HF). In 32% patients treated with HF, ARF improved (when initiated early mortality was 76.9% compared to a 100% when initiated in more advanced stages) (p < 0.001). Logistic regression analysis showed that ARF severity and haemodynamic failure were related with mortality.


CONCLUSIONS
ARF is a frequent and early complication of SAP, worsening its prognosis. FRA severity is related to the outcome. Need of replacement therapy supposes a high mortality. In this setting, HF seems to have advantages over conventional dialysis.
Herrera Gutiérrez
M E
ME
Servicio de Cuidados Críticos y Urgencias. Complejo Hospitalario Carlos Haya. Málaga. herrera@ctv.es
Seller Pérez
G
G
de La Rubia De Gracia
C
C
Chaparro Sánchez
M J
MJ
Nacle López
B
B
D018806:APACHE; D000208:Acute Disease; D058186:Acute Kidney Injury / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000209:etiology; D010195:Pancreatitis / Q000150:complications* / Q000401:mortality*; D011379:Prognosis; D006435:Renal Dialysis; D012189:Retrospective Studies; D016019:Survival Analysis