Acute renal failure in patients with severe sepsis and septic shock - a significant independent risk factor for mortality: results from the German Prevalence Study
Acute renal failure in patients with severe sepsis and septic shock - a significant independent risk factor for mortality: results from the German Prevalence Study
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DOI：
10.1093/ndt/gfm610
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发表时间：
2008-03-01
影响因子：
6.1
通讯作者：
John, Stefan
中科院分区：
文献类型：
--
作者：
Oppert, Michael;Engel, Christoph;John, Stefan
背景。关于严重脓毒症和脓毒性休克患者中急性肾功能衰竭（ARF）患病率的可靠数据缺乏。此外，尚不清楚ARF是脓毒症患者死亡的独立危险因素还是仅仅是疾病严重程度的一个指标。前瞻性横断面1天患病率研究在德国icu的代表性样本中进行，分为5个层次（< 200张床位；201-400张床位；401-600张床位；bb0 600张床位；大学医院）。共筛选3877例患者，其中415例发生严重脓毒症和脓毒性休克。14名患者（3.4%）患有慢性透析依赖性RF，并被排除在分析之外。在其余401例患者中，166例（41.4%）发生ARF，定义为肌酐升高超过正常上限的两倍以上和/或尿量下降至< 0.5 ml/kg体重。ARF患者中位APACHE II评分为22分，无ARF患者中位APACHE II评分为16分（p < 0.0001）。严重脓毒症/感染性休克患者的住院总死亡率为55.2%。ARF患者的住院死亡率为67.3%，无ARF患者为42.8% （p < 0.0001）。在调整APACHE II评分和年龄后，ARF仍然是死亡的重要独立危险因素[优势比（OR） 2.11, 95%可信区间（CI） 1.27-3.52]。脓毒症患者的死亡率与先前存在的非透析依赖的慢性肾脏疾病无关，而在透析依赖的脓毒症患者中死亡率增加到86%。在本次具有代表性的调查中，严重脓毒症/感染性休克患者ARF患病率较高，为41.4%。ARF是这些患者死亡的一个重要独立危险因素。
Background. Sound data about the prevalence of acute renal failure (ARF) among patients with severe sepsis and septic shock are lacking. Further, it is not known whether ARF is an independent risk factor for mortality in septic patients or merely an indicator of disease severity.Methods. A prospective cross-sectional one-day prevalence study was carried out in a representative sample of German ICUs, divided into five strata (< 200 beds; 201-400 beds; 401-600 beds; > 600 beds; university hospitals). 3877 patients were screened of whom 415 had severe sepsis and septic shock.Results. Fourteen patients (3.4%) had chronic dialysis-dependent RF and were excluded from analysis. Of the remaining 401 patients, 166 (41.4%) had ARF, as defined by a rise in creatinine above twice the upper limit of normal and/or a drop in urine output to < 0.5 ml/kg bodyweight. Median APACHE II score was 22 in patients with ARF and 16 in patients without ARF (p < 0.0001). Patients with severe sepsis/septic shock had an overall hospital mortality of 55.2%. Hospital mortality in patients with ARF was 67.3% and without ARF 42.8% (p < 0.0001). After adjustment for APACHE II score and age, ARF remained a significant independent risk factor for death [odds ratio (OR) 2.11, 95% confidence interval (CI) 1.27-3.52]. Mortality in septic patients was not associated with pre-existing, non-dialysis-dependent chronic kidney disease, whereas in dialysis-dependent patients with sepsis mortality increased to 86%.Conclusion. In this representative survey in patients with severe sepsis/septic shock, prevalence of ARF is high with 41.4%. ARF represents a significant independent risk factor for mortality in these patients.