Acute renal failure in critically ill patients - A multinational, multicenter study
Acute renal failure in critically ill patients - A multinational, multicenter study
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DOI：
10.1001/jama.294.7.813
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发表时间：
2005-08-17
影响因子：
120.7
通讯作者：
Ronco, C
中科院分区：
文献类型：
--
作者：
Uchino, S;Kellum, JA;Ronco, C
背景虽然急性肾功能衰竭（ARF）被认为是常见的危重病，并与死亡的高风险，很少有人知道它的流行病学和结果，或如何在不同地区的world.Objectives要确定在重症监护病房（ICU）患者在多个国家的ARF的期间患病率;表征病因学疾病严重程度和临床实践的差异;并确定这些差异对患者结果的影响。设计，设置，在接受肾脏替代治疗（RRT）的ICU患者中进行的前瞻性观察性研究或符合ARF的至少一个预定义标准。主要结果测量ARF的发生率，病因学因素，疾病严重程度，治疗，结果在研究期间收治的29269例危重患者中，有1738例（5.7%; 95%可信区间[CI]，5.5%-6.0%）在ICU期间发生ARF，其中1260例接受RRT治疗。ARF最常见的促发因素是脓毒性休克（47.5%; 95% CI，45.2%-49.5%）。大约30%的患者入院前有肾功能不全。总体住院死亡率为60.3%（95% CI，58.0%-62.6%）。出院时存活者的透析依赖性为13.8%（95% CI，11.2%-16.3%）。住院死亡的独立危险因素包括使用血管加压药（比值比[OR]，1.95; 95%CI，1.50-2.55; P
Context Although acute renal failure (ARF) is believed to be common in the setting of critical illness and is associated with a high risk of death, little is known about its epidemiology and outcome or how these vary in different regions of the world.Objectives To determine the period prevalence of ARF in intensive care unit (ICU) patients in multiple countries; to characterize differences in etiology illness severity, and clinical practice; and to determine the impact of these differences on patient outcomes.Design, Setting, and Patients Prospective observational study of ICU patients who either were treated with renal replacement therapy (RRT) or fulfilled at least 1 of the predefined criteria for ARF from September 2000 to December 2001 at 54 hospitals in 23 countries.Main Outcome Measures Occurrence of ARF, factors contributing to etiology, illness severity, treatment, need for renal support after hospital discharge, and hospital mortality.Results Of 29 269 critically ill patients admitted during the study period, 1738 (5.7%; 95% confidence interval [CI], 5.5%-6.0%) had ARF during their ICU stay, including 1260 who were treated with RRT. The most common contributing factor to ARF was septic shock (47.5%; 95% Cl, 45.2%-49.5%). Approximately 30% of patients had preadmission renal dysfunction. Overall hospital mortality was 60.3% (95% Cl, 58.0%-62.6%). Dialysis dependence at hospital discharge was 13.8% (95% Cl, 11.2%-16.3%) for survivors. Independent risk factors for hospital mortality included use of vasopressors (odds ratio [OR], 1.95; 95% Cl, 1.50-2.55; P