Mataloun S E, Machado F R, Senna A P R, Guimarães H P, Amaral J L G
Disciplina de Anestesiologia, Dor e Terapia Intensiva, Universidade Federal de São Paulo, Rua Napoleão de Barros 715, 04024-900 São Paulo, SP, Brazil.
Braz J Med Biol Res. 2006 Oct;39(10):1339-47. doi: 10.1590/s0100-879x2006001000010. Epub 2006 Aug 22.
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' chi2 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.
本研究的目的是评估重症监护病房中发生急性肾衰竭（ARF）患者的发病率、危险因素及预后。在这项前瞻性观察研究中，纳入了221例住院至少48小时、年龄至少18岁且无明显急性或慢性肾衰竭的患者。排除标准为器官捐献者和肾移植患者。ARF定义为肌酐水平高于1.5mg/dL。采用Pearson卡方检验、Student t检验和Wilcoxon检验进行统计学分析。多变量分析使用单变量分析中P<0.1的所有变量。19.0%的患者发生了ARF，其中76.19%导致死亡。主要危险因素（单变量分析）为：术中补液量和出血量较多、APACHE II评分提示死亡风险较高、入院首日的逻辑器官功能障碍系统评分、机械通气、全身炎症反应综合征（SIRS）/脓毒症所致休克、去甲肾上腺素使用情况以及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（1.340-13.642））、SIRS/脓毒症所致休克（OR=8.590（2.710-27.229））、术中补液量较多（OR=1.002（1.000-1.004））以及入院时血浆尿素水平（OR=1.012（0.980-1.044））在多变量分析中仍具有显著性。死亡危险因素（单变量分析）为SIRS/脓毒症所致休克、机械通气、血流感染、血钾和碳酸氢盐水平。只有血钾水平仍具有显著性（P=0.037）。总之，ARF在重症监护病房发生时具有较高的发病率、患病率和死亡率。它与血流动力学状态和多器官功能障碍密切相关。
