Clinical characteristics of patients developing ARF due to sepsis/systemic inflammatory response syndrome: results of a prospective study.
BACKGROUND
Acute renal failure (ARF) in patients with sepsis provokes high mortality and financial cost. In this prospective study, we collected characteristics of patients in the intensive care unit (ICU) who developed sepsis/systemic inflammatory response syndrome (SIRS) to analyze differences between those who subsequently did or did not develop ARF.


METHODS
All patients admitted to the ICU of the University Hospital Gent, Belgium, between January 1, 2001, and December 31, 2001, who developed sepsis/SIRS were included if they had a serum creatinine level less than 2 mg/dL (<177 micromol/L).


RESULTS
Of 2,442 patients admitted to the ICU, 257 patients developed sepsis/SIRS. Of those, 29 patients (11%) developed ARF. In a univariate analysis, age, central venous pressure (CVP), and serum creatinine and blood urea nitrogen levels were greater (P = 0.003, P = 0.006, P < 0.001, and P < 0.001, respectively), whereas mean arterial and diastolic blood pressures, 24-hour urinary output, arterial pH, bicarbonate level, thrombocyte count, albumin level, and prothrombin time were lower (P = 0.05, P = 0.004, P = 0.005, P = 0.03, P = 0.009, P = 0.037, P = 0.05, and P = 0.006, respectively) in the ARF group. Prevalence of diabetes, sex, and need for ventilation were not different between the ARF and no-ARF groups, but in the ARF group, diuretic use, vasopressor use, and presence of primary hepatic failure were more prevalent (P = 0.001 for each). In a multivariate analysis, age, serum creatinine level, CVP, and presence of liver failure significantly contributed to a logistic regression model for ARF.


CONCLUSIONS
Several parameters already were disturbed at the first day of SIRS/sepsis in patients who later developed ARF. Older age, elevated serum creatinine level despite elevated CVP, and presence of hepatic failure are predictive for ARF in septic patients.
Yegenaga
Itir
I
Department of Nephrology, Internal Medicine, Kocaeli University Medical School, Izmit, Turkey.
Hoste
Erik
E
Van Biesen
Wim
W
Vanholder
Raymond
R
Benoit
Dominique
D
Kantarci
Gulcin
G
Dhondt
Annemieke
A
Colardyn
Francis
F
Lameire
Norbert
N
D058186:Acute Kidney Injury / Q000209:etiology*; D000328:Adult; D000368:Aged; D003404:Creatinine / Q000097:blood; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D017093:Liver Failure; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D018746:Systemic Inflammatory Response Syndrome / Q000150:complications*
D003404:Creatinine