Long-term survival of chronic dialysis patients following survival from an episode of multiple-organ failure.
BACKGROUND
This study aimed to examine the long-term outcome for patients with end-stage renal failure (ESRF) who survived multiple-organ failure.


METHODS
We performed a review of databases from the renal medicine service and intensive care units (ICU) of the participating hospitals within Imperial College Healthcare NHS Trust, London, UK. Patients with ESRF admitted to ICU who required support of two or more organ systems or were ventilated for more than 36 hours were included. To provide a comparison we examined the survival of a comparator group of ESRF patients in the general population with similar demographic and disease characteristics to our study group. We also examined the outcome for ESRF patients admitted to ICU who died prior to discharge.


RESULTS
Survival data for two years following discharge from ICU were examined for the impact of age, prior dialysis history, Acute Physiology and Chronic Health Evaluation (APACHE) II scores and medical or surgical status. Of the 199 patients who met the inclusion criteria, 111 (56%) survived their ICU stay. Sixty-two (56%) of the survivors remained alive two years following discharge. There was no group difference in survival with regards to age, dialysis history or APACHE II scores. Those admitted with a medical rather than surgical diagnosis were less likely to survive two years (P < 0.01). Patients who died in ICU had higher APACHE II scores (P < 0.0001) and were more likely to have a medical diagnosis. By log rank analysis two-year mortality was significantly higher (P = 0.003) in the ICU survivors than the comparator group with ESRF. This difference was lost when patients who died within a month of discharge were excluded.


CONCLUSIONS
ESRF patients with multiple-organ failure have a high mortality, with the increased risk of death continuing into the early post-ICU period. Those with non-surgical diagnoses have the highest risk. Survival within the group who live beyond the early post-ICU period appears similar to the background population of ESRF patients.
Department of Anaesthetics, Southampton University Hospitals NHS Trust, Southampton General Hospital, Southampton, Hampshire SO16 6YD, UK. richardchapman@doctors.org.uk
Richard J
RJ
Chapman
Maie
M
Templeton
Simon
S
Ashworth
Robert
R
Broomhead
Adam
A
McLean
Stephen J
SJ
Brett
D000367:Age Factors; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000401:mortality*; D008131:London / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000150:complications*; D006435:Renal Dialysis; D012189:Retrospective Studies; D012306:Risk; D015996:Survival Rate; D013997:Time Factors