Létourneau Isabelle, Dorval Marc, Bélanger Robert, Légaré Martin, Fortier Louise, Leblanc Martine
Department of Nephrology, Maisonneuve-Rosemont Hospital and Guy-Bernier Research Center, University of Montreal, Que, Canada.
Nephron. 2002 Apr;90(4):408-12. doi: 10.1159/000054728.
BACKGROUND/AIMS: Review of bone marrow transplant (BMT) cases admitted to our intensive care unit (ICU) and to compare co-morbidity and outcome of BMT patients developing or not developing acute renal failure (ARF).
A case review of BMT patients admitted to the ICU (a 16-bed medico-surgical ICU in a tertiary care teaching institution) over a 4-year period.
Between January 1994 and December 1998, 57 among 441 BMT patients (12.9%) were admitted to the ICU, mainly for respiratory distress (58%) and hypotension (32%). Forty-two patients (73.7%) presented ARF as defined as a doubling of serum creatinine. Compared to the 15 other patients, ARF patients had a higher APACHE II score (30 +/- 8 vs. 25 +/- 7, p < 0.05). For ARF vs. non-ARF patients, there was no difference in age (43.8 +/- 10.8 vs. 44.3 +/- 11.1 years), in requirement for mechanical ventilation (76 vs. 73%) and vasopressors (69 vs. 60%), and in prevalence of graft-versus-host disease (19 vs. 13%) or neutropenia (69 vs. 67%), but the prevalence of sepsis (83 vs. 60%) and liver failure (69 vs. 40%) was higher. Maximum serum bilirubin was markedly increased in ARF compared to non-ARF patients (p < 0.005). For both subgroups, no difference in the administration of potential nephrotoxic agents was identified. Usually, ARF was considered multifactorial by clinicians, with ATN being the most frequent diagnosis (55%). Maximum serum creatinine reached a mean of 330 +/- 130 micromol/l. In 74% of cases, ARF occurred concomitantly or after admission to the ICU. Oligoanuria was present in 38%, whereas polyuria was observed in 17%. Fourteen ARF patients (33%) required dialytic support. Mortality rates were significantly different in ARF vs. non-ARF patients (88 vs. 60%, p < 0.05). Predictive factors for the development of ARF were liver failure (odds ratio (OR) 5.9), low serum albumin (OR 1.2) and APACHE II score (OR 1.1), whereas variables predictive of mortality were mechanical ventilation (OR 14.8), ARF (OR 5.8), liver failure (OR 3.7), and APACHE II score (OR 1.2).
This study confirms that ARF in BMT patients admitted to the ICU is frequent, multifactorial, related to liver failure, and that its development has a negative impact on outcome.
背景/目的：回顾入住我们重症监护病房（ICU）的骨髓移植（BMT）病例，并比较发生或未发生急性肾衰竭（ARF）的BMT患者的合并症及预后。
对一所三级护理教学机构中一间拥有16张床位的内科-外科ICU在4年期间收治的BMT患者进行病例回顾。
1994年1月至1998年12月期间，441例BMT患者中有57例（12.9%）入住ICU，主要原因是呼吸窘迫（58%）和低血压（32%）。42例患者（73.7%）出现符合血清肌酐翻倍定义的ARF。与其他15例患者相比，ARF患者的急性生理与慢性健康状况评分系统（APACHE）II评分更高（30±8对25±7，p<0.05）。对于ARF患者与非ARF患者，年龄（43.8±10.8对44.3±11.1岁）、机械通气需求（76%对73%）、血管升压药需求（69%对60%）、移植物抗宿主病患病率（19%对13%）或中性粒细胞减少症患病率（69%对67%）无差异，但败血症患病率（83%对60%）和肝衰竭患病率（69%对40%）更高。与非ARF患者相比，ARF患者的血清总胆红素最大值显著升高（p<0.005）。对于两个亚组，未发现潜在肾毒性药物使用方面的差异。通常，临床医生认为ARF是多因素导致的，急性肾小管坏死（ATN）是最常见的诊断（55%）。血清肌酐最大值平均达到330±130微摩尔/升。74%的病例中，ARF在入住ICU时或之后出现。38%的患者出现少尿，而17%的患者出现多尿。14例ARF患者（33%）需要透析支持。ARF患者与非ARF患者的死亡率有显著差异（88%对60%，p<0.05）。ARF发生的预测因素为肝衰竭（优势比（OR）5.9）、低血清白蛋白（OR 1.2）和APACHE II评分（OR 1.1），而死亡的预测变量为机械通气（OR 14.8）、ARF（OR 5.8）、肝衰竭（OR 3.7）和APACHE II评分（OR 1.2）。
本研究证实，入住ICU的BMT患者中ARF很常见，是多因素导致的，与肝衰竭有关，且其发生对预后有负面影响。
