title: Mortality predictors in renal transplant recipients with severe sepsis and septic shock.
abstract: BACKGROUND
  The growing number of renal transplant recipients in a sustained immunosuppressive state is a factor that can contribute to increased incidence of sepsis. However, relatively little is known about sepsis in this population. The aim of this single-center study was to evaluate the factors associated with hospital mortality in renal transplant patients admitted to the intensive care unit (ICU) with severe sepsis and septic shock.
  
  
  METHODS
  Patient demographics and transplant-related and ICU stay data were retrospectively collected. Multiple logistic regression was conducted to identify the independent risk factors associated with hospital mortality.
  
  
  RESULTS
  A total of 190 patients were enrolled, 64.2% of whom received kidneys from deceased donors. The mean patient age was 51 ± 13 years (males, 115 [60.5%]), and the median APACHE II was 20 (16-23). The majority of patients developed sepsis late after the renal transplantation (2.1 [0.6-2.3] years). The lung was the most common infection site (59.5%). Upon ICU admission, 16.4% of the patients had ≤ 1 systemic inflammatory response syndrome criteria. Among the patients, 61.5% presented with ≥ 2 organ failures at admission, and 27.9% experienced septic shock within the first 24 hours of ICU admission. The overall hospital mortality rate was 38.4%. In the multivariate analysis, the independent determinants of hospital mortality were male gender (OR = 5.9; 95% CI, 1.7-19.6; p = 0.004), delta SOFA 24 h (OR = 1.7; 95% CI, 1.2-2.3; p = 0.001), mechanical ventilation (OR = 30; 95% CI, 8.8-102.2; p<0.0001), hematologic dysfunction (OR = 6.8; 95% CI, 2.0-22.6; p = 0.002), admission from the ward (OR = 3.4; 95% CI, 1.2-9.7; p = 0.02) and acute kidney injury stage 3 (OR = 5.7; 95% CI,1.9-16.6; p = 0.002).
  
  
  CONCLUSIONS
  Hospital mortality in renal transplant patients with severe sepsis and septic shock was associated with male gender, admission from the wards, worse SOFA scores on the first day and the presence of hematologic dysfunction, mechanical ventilation or advanced graft dysfunction.
authors.affiliation: Unidade de Transplante, Disciplina de Nefrologia, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
authors.forename: Mônica Andrade
authors.initials: MA
authors.lastname: de Carvalho
authors.affiliation: Unidade de Transplante, Disciplina de Nefrologia, Universidade Federal de São Paulo, São Paulo, SP, Brazil; Disciplina de Anestesiologia, Dor e Terapia Intensiva. Universidade Federal de São Paulo, São Paulo, SP, Brazil.
authors.forename: Flávio Geraldo Rezende
authors.initials: FG
authors.lastname: Freitas
authors.affiliation: Unidade de Transplante, Disciplina de Nefrologia, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
authors.forename: Hélio Tedesco
authors.initials: HT
authors.lastname: Silva Junior
authors.affiliation: Unidade de Transplante, Disciplina de Nefrologia, Universidade Federal de São Paulo, São Paulo, SP, Brazil; Disciplina de Anestesiologia, Dor e Terapia Intensiva. Universidade Federal de São Paulo, São Paulo, SP, Brazil.
authors.forename: Antônio Toneti
authors.initials: AT
authors.lastname: Bafi
authors.affiliation: Disciplina de Anestesiologia, Dor e Terapia Intensiva. Universidade Federal de São Paulo, São Paulo, SP, Brazil.
authors.forename: Flávia Ribeiro
authors.initials: FR
authors.lastname: Machado
authors.affiliation: Unidade de Transplante, Disciplina de Nefrologia, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
authors.forename: José Osmar Medina
authors.initials: JO
authors.lastname: Pestana
mesh_terms: D018806:APACHE; D000328:Adult; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000401:mortality*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000150:complications* / Q000401:mortality; D012772:Shock, Septic / Q000150:complications* / Q000401:mortality; D066027:Transplant Recipients