Effects of early changes in organ dysfunctions on the outcomes of critically ill patients in need of renal replacement therapy.
BACKGROUND
Acute kidney injury usually develops in critically ill patients in the context of multiple organ dysfunctions.


OBJECTIVE
To evaluate the effect of changes in associated organ dysfunctions over the first three days of renal replacement therapy on the outcomes of patients with acute kidney injury.


METHODS
Over a 19-month period, we evaluated 260 patients admitted to the intensive care units of three tertiary-care hospitals who required renal replacement therapy for > 48 h. Organ dysfunctions were evaluated by SOFA score (excluding renal points) on the first (D1) and third (D3) days of renal replacement therapy. Absolute (A-SOFA) and relative (Delta-SOFA) changes in SOFA scores were also calculated.


RESULTS
Hospital mortality rate was 75%. Organ dysfunctions worsened (A-SOFA>0) in 53%, remained unchanged (A-SOFA=0) in 17% and improved (A-SOFA<0) in 30% of patients; and mortality was lower in the last group (80% vs. 84% vs. 61%, p=0.003). SOFA on D1 (p<0.001), SOFA on D3 (p<0.001), A-SOFA (p=0.019) and Delta-SOFA (p=0.016) were higher in non-survivors. However, neither A-SOFA nor Delta-SOFA discriminated survivors from non-survivors on an individual basis. Adjusting for other covariates (including SOFA on D1), A-SOFA and Delta-SOFA were associated with increased mortality, and patients in whom SOFA scores worsened or remained unchanged had poorer outcomes.


CONCLUSIONS
In addition to baseline values, early changes in SOFA score after the start of renal replacement therapy were associated with hospital mortality. However, no prognostic score should be used as the only parameter to predict individual outcomes.
Maccariello
Elizabeth
E
D'Or de Hospitais, Rio de Janeiro, Brazil. emaccariello@yahoo.com.br
Rocha
Eduardo
E
Valente
Carla
C
Nogueira
Lina
L
Rocha
Pedro T
PT
Bonomo
Hélio
H
Serpa
Luciana F
LF
Ismael
Márcia
M
Valença
Ricardo V R
RV
Machado
José E S
JE
Soares
Márcio
M
D058186:Acute Kidney Injury / Q000401:mortality / Q000628:therapy; D000368:Aged; D001938:Brazil / Q000453:epidemiology; D016638:Critical Illness / Q000401:mortality*; D005260:Female; D015600:Glasgow Coma Scale; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D009102:Multiple Organ Failure / Q000401:mortality*; D011446:Prospective Studies; D006435:Renal Dialysis; D017582:Renal Replacement Therapy / Q000401:mortality*; D012720:Severity of Illness Index; D016019:Survival Analysis; D016896:Treatment Outcome