Incidence, risk factors and prognostic factors of acute renal failure in patients admitted to an intensive care unit
Incidence, risk factors and prognostic factors of acute renal failure in patients admitted to an intensive care unit
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DOI：
10.1590/s0100-879x2006001000010
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发表时间：
2006-10-01
影响因子：
2.3
通讯作者：
Amaral, J.L.G.
中科院分区：
文献类型：
--
作者：
Mataloun, S.E.;Machado, F.R.;Amaral, J.L.G.
本研究的目的是评估重症监护病房急性肾功能衰竭（ARF）患者的发病率、危险因素和预后。在这项前瞻性观察性研究中，221例患者最小住院时间为48小时，最小年龄为18岁，没有明显的急性或慢性肾功能衰竭。排除标准为器官供体和肾移植患者。ARF的定义是肌酐水平高于1.5 mg/dL。统计学采用pearson’chi(2)检验、Student t检验和Wilcoxon检验。采用单因素分析中P < 0.1的所有变量进行多因素分析。19.0%的患者发生ARF， 76.19%的患者死亡。主要危险因素（单因素分析）为：术中较高的水合和出血、APACHE II评分较高的死亡风险、第一天医生器官功能障碍系统、机械通气、全身炎症反应综合征(SIRS)/败血症引起的休克、去甲肾上腺素的使用、入院时血浆肌酐和尿素水平。入院时心率（OR = 1.023(1.002-1.044)）、男性（OR = 4.275(1.340-13642)）、SIRS/脓毒症引起的休克（OR = 8.590(2.710-27.229)）、术中较高的水分（OR = 1.002(1.000-1004)）、入院时血浆尿素（OR = 1.012(0.980-1044)）仍具有显著性（多因素分析）。死亡危险因素（单因素分析）为SIRS/败血症引起的休克、机械通气、血流感染、钾和碳酸氢盐水平。只有钾水平保持显著性（P = 0.037）。总之，在重症监护病房发生ARF的发病率、发病率和死亡率都很高。它与血流动力学状态和多器官功能障碍密切相关。
The objective of the present study was to assess the incidence, risk factors and outcome of patients who develop acute renal failure (ARF) in intensive care units. In this prospective observational study, 221 patients with a 48-h minimum stay, 18-year-old minimum age and absence of overt acute or chronic renal failure were included. Exclusion criteria were organ donors and renal transplantation patients. ARF was defined as a creatinine level above 1.5 mg/dL. Statistics were performed using Pearsons' chi(2) test, Student t-test, and Wilcoxon test. Multivariate analysis was run using all variables with P < 0.1 in the univariate analysis. ARF developed in 19.0% of the patients, with 76.19% resulting in death. Main risk factors (univariate analysis) were: higher intra-operative hydration and bleeding, higher death risk by APACHE II score, logist organ dysfunction system on the first day, mechanical ventilation, shock due to systemic inflammatory response syndrome (SIRS)/sepsis, noradrenaline use, and plasma creatinine and urea levels on admission. Heart rate on admission (OR = 1.023 (1.002-1.044)), male gender (OR = 4.275 (1.340-13642)), shock due to SIRS/sepsis (OR = 8.590 (2.710-27.229)), higher intra-operative hydration (OR = 1.002 (1.000-1004)), and plasma urea on admission (OR = 1.012 (0.980-1044)) remained significant (multivariate analysis). The mortality risk factors (univariate analysis) were shock due to SIRS/sepsis, mechanical ventilation, blood stream infection, potassium and bicarbonate levels. Only potassium levels remained significant (P = 0.037). In conclusion, ARF has a high incidence, morbidity and mortality when it occurs in intensive care unit. There is a very close association with hemodynamic status and multiple organ dysfunction.