de Mendonça A, Vincent J L, Suter P M, Moreno R, Dearden N M, Antonelli M, Takala J, Sprung C, Cantraine F
Department of Intensive Care, Erasme University Hospital, Brussels, Belgium.
Intensive Care Med. 2000 Jul;26(7):915-21. doi: 10.1007/s001340051281.
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.
Prospective, multicenter, observational cohort analysis.
Forty ICUs in 16 countries.
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.
Of the patients, 348 (24.7%) developed ARF, as diagnosed by a serum creatinine of 300 micromol/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.
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.
描述重症监护病房（ICU）患者发生急性肾衰竭（ARF）的危险因素，以及使用序贯器官衰竭评估（SOFA）评分评估ARF与多器官功能衰竭（MOF）及预后的相关性。
前瞻性、多中心、观察性队列分析。
16个国家的40个ICU。
纳入1995年5月入住任何一家参与研究的ICU的所有患者，但不包括那些在非复杂性手术后在ICU停留时间少于48小时的患者。排除38例有慢性肾衰竭病史且需要肾脏替代治疗的患者后，共对1411例患者进行了研究。
在这些患者中，348例（24.7%）发生了ARF，诊断标准为血清肌酐达到300微摩尔/升（3.5毫克/分升）及以上和/或尿量少于500毫升/天。入院时存在的导致ARF的最重要危险因素是急性循环或呼吸衰竭；年龄超过65岁、存在感染、有慢性心力衰竭（CHF）、淋巴瘤或白血病病史或肝硬化病史。ARF患者比非ARF患者更早发生MOF（ICU入院后中位数分别为24小时和48小时，p<0.05）。年龄超过65岁且有CHF病史或入院时存在任何器官功能衰竭的ARF患者最有可能发生MOF。ARF患者的ICU死亡率是非ARF患者的3倍（42.8%对14.0%，p<0.01）。经多变量回归分析确定，少尿型ARF是总体死亡率的独立危险因素（比值比=1.59[95%置信区间：1.23 - 2.06]，p<0.01）。感染增加了与所有因素相关的死亡风险。增加ARF患者ICU死亡率的因素包括血液系统恶性肿瘤病史、年龄超过65岁、入院时衰竭器官的数量以及存在急性心血管衰竭。
在ICU患者中，导致ARF或ARF死亡的最重要危险因素往往在入院时就已存在。在ICU住院期间，其他器官功能衰竭（尤其是心血管功能衰竭）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影响。循环性休克的严重程度是影响ARF患者预后的最重要因素。
