Spectrum of acute renal failure in the intensive care unit: The PICARD experience
Spectrum of acute renal failure in the intensive care unit: The PICARD experience
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DOI：
10.1111/j.1523-1755.2004.00927.x
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发表时间：
2004-10-01
影响因子：
19.6
通讯作者：
Chertow, GM
中科院分区：
文献类型：
--
作者：
Mehta, RL;Pascual, MT;Chertow, GM
背景重症患者的急性肾衰竭（ARF）与极高的死亡率相关。了解ARF的变化谱将是必要的，以促进质量改进的努力，并设计成功的介入试验。我们对美国五个学术医学中心的618名重症监护室的ARF患者进行了一项观察性队列研究。要求参与者签署（或由代理人签署）数据收集知情同意书。一个全面的数据收集工具收集了800多个变量，大多数是在整个东盟区域论坛期间每天收集的。患者的特征、透析状态和主要结果被确定并按临床地点分层。平均年龄为59.5岁，41%为女性，20%为少数民族或种族。存在广泛的共病; 30%患有慢性肾脏疾病，37%患有冠状动脉疾病，29%患有糖尿病，21%患有慢性肝病。大多数患者，即使是不需要透析的患者，急性肾功能衰竭也伴有肾外器官系统衰竭。398例（64%）患者需要透析。住院死亡率为37%，死亡率或肾功能不恢复率为50%。中位住院时间为25天（26天，不包括死亡患者）。危重病患者的ARF谱不断变化，其特征是合并症和广泛的肾外并发症的巨大负担，使得大多数患者需要透析。各机构的患者特征和实践模式存在很大差异。这些差异强调了对ARF进行额外多中心观察性和干预性研究的必要性。
Background. Acute renal failure (ARF) in the critically ill is associated with extremely high mortality rates. Understanding the changing spectrum of ARF will be necessary to facilitate quality improvement efforts and to design successful interventional trials.Methods. We conducted an observational cohort study of 618 patients with ARF in intensive care units at five academic medical centers in the United States. Participants were required to sign (or have a proxy sign) informed consent for data collection. A comprehensive data collection instrument captured more than 800 variables, most on a daily basis, throughout the course of ARF. Patient characteristics, dialysis status, and major outcomes were determined and stratified by clinical site.Results. The mean age was 59.5 years, 41% were women, and 20% were of minority race or ethnicity. There was extensive comorbidity; 30% had chronic kidney disease, 37% had coronary artery disease, 29% had diabetes mellitus, and 21% had chronic liver disease. Acute renal failure was accompanied by extrarenal organ system failure in most patients, even those who did not require dialysis. Three hundred and ninety-eight (64%) patients required dialysis. The in-hospital mortality rate was 37%, and the rate of mortality or nonrecovery of renal function was 50%. The median hospital length of stay was 25 days (26 days, excluding patients who died).Conclusion. There is a changing spectrum of ARF in the critically ill, characterized by a large burden of comorbid disease and extensive extrarenal complications, obligating the need for dialysis in the majority of patients. There is wide variation across institutions in patient characteristics and practice patterns. These differences highlight the need for additional multicenter observational and interventional studies in ARF.