Schroeder T H, Hansen M, Dinkelaker K, Krueger W A, Nohé B, Fretschner R, Unertl K
Department of Anaesthesiology and Critical Care Medicine, Tuebingen University Hospital, Tuebingen, Germany.
Eur J Anaesthesiol. 2004 Nov;21(11):848-53. doi: 10.1017/s026502150400016x.
The development of acute renal failure (ARF) in critically ill patients is associated with an increase in hospital mortality. Recently, it was shown that starting renal replacement therapy early and using high-filtrate flow rates can improve the outcome, but this could not be confirmed in later investigations. Studying selected patient subgroups could provide a useful basis for patient selection in future trials evaluating the outcome of renal replacement therapies. We, therefore, investigated the impact of the underlying disease on the outcome of patients with ARF.
We retrospectively analysed 306 patients with ARF who were treated with renal replacement therapy. Patients were classified according to six initial diagnosis groups: haemorrhagic shock, post-cardiac surgery, post-liver transplantation, trauma, severe sepsis and miscellaneous. Univariate and multivariate multiple logistic regression analysis was used to determine which factors influenced the outcome.
Underlying disease proved to be the only independent risk factor for mortality that was present at intensive care unit (ICU) admission (P = 0.047). Patients with severe sepsis had a significantly higher mortality rate (68%) than ARF patients as a whole (51%) (P = 0.02). Length of stay in the ICU, the use of catecholamines, the delay before ARF onset, and the correlation between APACHE II score and ICU length of stay proved to be additional independent predictors of outcome.
Patient selection and subgroup definition according to the underlying disease could augment the usefulness of future trials evaluating the outcome of ARF.
危重症患者急性肾衰竭（ARF）的发生与医院死亡率升高相关。最近有研究表明，早期开始肾脏替代治疗并采用高滤过流速可改善预后，但在后续研究中未能得到证实。研究特定患者亚组可为未来评估肾脏替代治疗预后的试验中的患者选择提供有用依据。因此，我们研究了基础疾病对ARF患者预后的影响。
我们回顾性分析了306例接受肾脏替代治疗的ARF患者。根据六个初始诊断组对患者进行分类：失血性休克、心脏手术后、肝移植后、创伤、严重脓毒症和其他。采用单因素和多因素多元逻辑回归分析来确定哪些因素影响预后。
基础疾病被证明是重症监护病房（ICU）入院时存在的唯一独立死亡风险因素（P = 0.047）。严重脓毒症患者的死亡率（68%）显著高于总体ARF患者（51%）（P = 0.02）。ICU住院时间、儿茶酚胺的使用、ARF发作前的延迟以及急性生理与慢性健康状况评分系统（APACHE II）评分与ICU住院时间之间的相关性被证明是预后的其他独立预测因素。
根据基础疾病进行患者选择和亚组定义可增强未来评估ARF预后试验的实用性。
