Acute renal failure in the ICU:: risk factors and outcome evaluated by the SOFA score
Acute renal failure in the ICU:: risk factors and outcome evaluated by the SOFA score
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DOI：
10.1007/s001340051281
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发表时间：
2000-07-01
影响因子：
38.9
通讯作者：
Cantraine, F
中科院分区：
文献类型：
--
作者：
de Mendonça, A;Vincent, JL;Cantraine, F
目的：通过序贯器官衰竭评估(SOFA)评分，描述重症监护病房(ICU)患者发生急性肾功能衰竭(ARF)的危险因素，以及ARF与多器官衰竭(MOF)和预后的关系。设计：前瞻性、多中心、观察性队列分析。地点：16个国家的40个ICU。患者：除非并发症手术后入住ICU时间<48h者外，所有患者均于1995年5月在其中一个参与ICU入院。排除了38名有慢性肾功能衰竭病史需要肾脏替代治疗的患者后，共有1411名患者接受了研究。测量和结果：348例(24.7%)患者发生ARF，诊断为血肌酐300Mol/L(3.5mgdl)或以上和(或)尿量<500ml/d。入院时发生ARF的最重要的危险因素是急性循环或呼吸衰竭、年龄超过65岁、感染、既往慢性心力衰竭(CHF)病史、淋巴瘤或白血病或肝硬变。ARF患者比非ARF患者更早发生多器官功能衰竭(ICU入院后中位数24小时比48小时，p<；0.05)。年龄大于65岁、既往有CHF病史或入院时有任何器官衰竭的ARF患者最有可能发生MOF。ARF患者的ICU死亡率是其他患者的3倍(42.8%vs14.0%，p<；0.01)。经多因素回归分析，少尿型ARF是总死亡率的独立危险因素(OR=1.59[CI 95%：1.23-2.06]，p<；0.01)。感染增加了与所有因素相关的死亡风险。影响ARF患者ICU病死率的因素有：既往血液系统恶性肿瘤史、年龄>65岁、入院时器官衰竭个数和急性心血管衰竭。结论：在ICU患者中，ARF或ARF死亡率最重要的危险因素往往出现在入院时。在ICU期间，其他器官衰竭(特别是心血管衰竭)是重要的危险因素。少尿型ARF是ICU死亡率的独立危险因素，感染增加了其他因素对死亡率的贡献。循环休克的严重程度是影响ARF患者预后的最重要因素。
Objectives: To describe risk factors for the development of acute renal failure (ARF) in a population of intensive care unit (ICU) patients, and the association of ARF with multiple organ failure (MOF) and outcome using the sequential organ failure assessment (SOFA) score. Design: Prospective, multicenter, observational cohort analysis. Setting: Forty ICUs in 16 countries. Patients: All patients admitted to one of the participating ICUs in May 1995, except those who stayed in the ICU for less than 48 h after uncomplicated surgery were included. After the exclusion of 38 patients with a history of chronic renal failure requiring renal replacement therapy, a total of 1411 patients were studied. Measurements and results: Of the patients, 348 (24.7 %) developed ARF, as diagnosed by a serum creatinine of 300 mu mol/l (3.5 mg/dl) or more and/or a urine output of less than 500 ml/day. The most important risk factors for the development of ARF present on admission were acute circulatory or respiratory failure; age more than 65 years, presence of infection, past history of chronic heart failure (CHF), lymphoma or leukemia, or cirrhosis. ARF patients developed MOF earlier than non-ARF patients (median 24 vs 48 h after ICU admission, p < 0.05). ARF patients older than 65 years with a past history of CHF or with any organ failure on admission were most likely to develop MOF. ICU mortality was 3 times higher in ARF than in other patients (42.8 % vs 14.0 %, p < 0.01). Oliguric ARF was an independent risk factor for overall mortality as determined by a multivariate regression analysis (OR = 1.59 [CI 95 %: 1.23-2.06], p < 0.01). Infection increased the risk of death associated with all factors. Factors that increased the ICU mortality of ARF patients were a past history of hematologic malignancy, age more than 65 years, the number of failing organs on admission and the presence of acute cardiovascular failure. Conclusion: In ICU patients, the most important risk factors for ARF or mortality from ARF are often present on admission. During the ICU stay, other organ failures (especially cardiovascular) are important risk factors. Oliguric ARF was an independent risk factor for ICU mortality, and infection increased the contribution to mortality by other factors. The severity of circulatory shock was the most important factor influencing outcome in ARF patients.