Influence of underlying disease on the outcome of critically ill patients with acute renal failure.
OBJECTIVE
The development of acute renal failure (ARF) in critically ill patients is associated with an increase in hospital mortality. Recently, it was shown that starting renal replacement therapy early and using high-filtrate flow rates can improve the outcome, but this could not be confirmed in later investigations. Studying selected patient subgroups could provide a useful basis for patient selection in future trials evaluating the outcome of renal replacement therapies. We, therefore, investigated the impact of the underlying disease on the outcome of patients with ARF.


METHODS
We retrospectively analysed 306 patients with ARF who were treated with renal replacement therapy. Patients were classified according to six initial diagnosis groups: haemorrhagic shock, post-cardiac surgery, post-liver transplantation, trauma, severe sepsis and miscellaneous. Univariate and multivariate multiple logistic regression analysis was used to determine which factors influenced the outcome.


RESULTS
Underlying disease proved to be the only independent risk factor for mortality that was present at intensive care unit (ICU) admission (P = 0.047). Patients with severe sepsis had a significantly higher mortality rate (68%) than ARF patients as a whole (51%) (P = 0.02). Length of stay in the ICU, the use of catecholamines, the delay before ARF onset, and the correlation between APACHE II score and ICU length of stay proved to be additional independent predictors of outcome.


CONCLUSIONS
Patient selection and subgroup definition according to the underlying disease could augment the usefulness of future trials evaluating the outcome of ARF.
Schroeder
T H
TH
Department of Anaesthesiology and Critical Care Medicine, Tuebingen University Hospital, Tuebingen, Germany. torsten.schroeder@uni-tuebingen.de
Hansen
M
M
Dinkelaker
K
K
Krueger
W A
WA
Nohé
B
B
Fretschner
R
R
Unertl
K
K
D058186:Acute Kidney Injury / Q000150:complications* / Q000401:mortality / Q000628:therapy*; D000328:Adult; D000368:Aged; D002395:Catecholamines / Q000627:therapeutic use; D016638:Critical Illness; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D018579:Patient Selection; D011237:Predictive Value of Tests; D012372:ROC Curve; D017582:Renal Replacement Therapy / Q000379:methods* / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D016896:Treatment Outcome
D002395:Catecholamines