title: Fluid management and risk factors for renal dysfunction in patients with severe sepsis and/or septic shock.
abstract: BACKGROUND
  The causative role of new hydroxyethyl starch (HES 130/0.4) in renal dysfunction frequency (a > 50% increase in serum creatinine or need for renal replacement therapy (RRT)) remains debated. Using the database of a multicenter study focusing on patients with severe sepsis and septic shock, the present study aimed at identifying factors associated with the occurrence of renal dysfunction.
  
  
  METHODS
  Among the 435 patients in a multicenter study of patients with severe sepsis and septic shock in 15 Southern French ICUs, 388 patients surviving after 24 hour, without a history of renal failure were included. Factors associated with renal dysfunction and RRT were isolated using a multivariate analysis with logistic regression.
  
  
  RESULTS
  Renal dysfunction was reported in 117 (33%) patients. Ninety patients required RRT. Among study participants, 379 (98%) were administered fluids in the first 24 hours of management: HES 130/0.4 only (n=39), crystalloids only (n=63), or both HES 130/0.4 and crystalloids (n=276). RRT was independently associated with the need for vasopressors and the baseline value of serum creatinine in the first 24 hours. Multivariate analysis indicated that male gender, SAPS II score, being a surgical patient, lack of decrease in SOFA score during the first 24 hours, and the interventional period of the study were independently associated with renal dysfunction. Mortality increased in the presence of renal dysfunction (48% versus 24%, P<0.01).
  
  
  CONCLUSIONS
  Despite being used in more than 80% of patients with severe sepsis and/or septic shock, the administration of HES 130/0.4 in the first 24 hours of management was not associated with the occurrence of renal dysfunction.
authors.affiliation: Division Anesthésie Réanimation Douleur Urgences, CHU de Nîmes, Place du Professeur Robert Debré, 30029 Nîmes Cedex 9, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Muller
authors.forename: Samir
authors.initials: S
authors.lastname: Jaber
authors.forename: Nicolas
authors.initials: N
authors.lastname: Molinari
authors.forename: Laurent
authors.initials: L
authors.lastname: Favier
authors.forename: Jérôme
authors.initials: J
authors.lastname: Larché
authors.forename: Gilles
authors.initials: G
authors.lastname: Motte
authors.forename: Sonia
authors.initials: S
authors.lastname: Lazarovici
authors.forename: Luc
authors.initials: L
authors.lastname: Jacques
authors.forename: Sandrine
authors.initials: S
authors.lastname: Alonso
authors.forename: Marc
authors.initials: M
authors.lastname: Leone
authors.forename: Jean Michel
authors.initials: JM
authors.lastname: Constantin
authors.forename: Bernard
authors.initials: B
authors.lastname: Allaouchiche
authors.forename: Carey
authors.initials: C
authors.lastname: Suehs
authors.forename: Jean-Yves
authors.initials: JY
authors.lastname: Lefrant
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced / Q000401:mortality; D000368:Aged; D019468:Disease Management; D005260:Female; D005440:Fluid Therapy / Q000009:adverse effects; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000008:administration & dosage* / Q000009:adverse effects; D007668:Kidney / Q000187:drug effects* / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D018805:Sepsis / Q000401:mortality / Q000628:therapy; D012737:Sex Factors; D012772:Shock, Septic / Q000401:mortality / Q000628:therapy*
chemical_list: C485123:HES 130-0.4; D006895:Hydroxyethyl Starch Derivatives