Silva Júnior Geraldo Bezerra da, Daher Elizabeth De Francesco, Mota Rosa Maria Salani, Menezes Francisco Albano
Intensive Care Unit of Hospital Universitário Walter Cantídio, School of Medicine, Universidade Federal do Ceará, Rua Mário Alencar Araripe 61, Fortaleza, Ceará, Brazil.
Sao Paulo Med J. 2006 Sep 7;124(5):257-63. doi: 10.1590/s1516-31802006000500004.
Acute renal failure is a common medical problem, with a high mortality rate. The aim of this work was to investigate the risk factors for death among critically ill patients with acute renal failure.
Retrospective cohort at the intensive care unit of Hospital Universitário Walter Cantídio, Fortaleza.
Survivors and non-survivors were compared. Univariate and multivariate analyses were performed to establish risk factors for death.
Acute renal failure occurred in 128 patients (33.5%), with mean age of 49 +/- 20 years (79 males; 62%). Death occurred in 80 (62.5%). The risk factors most frequently associated with death were hypotension, sepsis, nephrotoxic drug use, respiratory insufficiency, liver failure, hypovolemia, septic shock, multiple organ dysfunction, need for vasoactive drugs, need for mechanical ventilation, oliguria, hypoalbuminemia, metabolic acidosis and anemia. There were negative correlations between death and: prothrombin time, hematocrit, hemoglobin, systolic blood pressure, diastolic blood pressure, arterial pH, arterial bicarbonate and urine volume. From multivariate analysis, the independent risk factors for death were: need for mechanical ventilation (OR = 3.15; p = 0.03), hypotension (OR = 3.48; p = 0.02), liver failure (OR = 5.37; p = 0.02), low arterial bicarbonate (OR = 0.85; p = 0.005), oliguria (OR = 3.36; p = 0.009), vasopressor use (OR = 4.83; p = 0.004) and sepsis (OR = 6.14; p = 0.003).
There are significant risk factors for death among patients with acute renal failure in intensive care units, which need to be identified at an early stage for early treatment.
急性肾衰竭是常见的医学问题，死亡率很高。本研究旨在调查急性肾衰竭重症患者的死亡危险因素。
在福塔雷萨市沃尔特·坎蒂迪奥大学医院重症监护病房进行的回顾性队列研究。
对存活患者和非存活患者进行比较。采用单因素和多因素分析确定死亡危险因素。
128例患者（33.5%）发生急性肾衰竭，平均年龄49±20岁（男性79例，占62%）。80例（62.5%）死亡。与死亡最常相关的危险因素为低血压、脓毒症、使用肾毒性药物、呼吸功能不全、肝功能衰竭、血容量不足、感染性休克、多器官功能障碍、需要血管活性药物、需要机械通气、少尿、低白蛋白血症、代谢性酸中毒和贫血。死亡与以下因素呈负相关：凝血酶原时间、血细胞比容、血红蛋白、收缩压、舒张压、动脉pH值、动脉碳酸氢盐和尿量。多因素分析显示，死亡的独立危险因素为：需要机械通气（比值比[OR]=3.15；p=0.03）、低血压（OR=3.48；p=0.02）、肝功能衰竭（OR=5.37；p=0.02）、动脉碳酸氢盐水平低（OR=0.85；p=0.005）、少尿（OR=3.36；p=0.009）、使用血管升压药（OR=4.83；p=0.004）和脓毒症（OR=6.14；p=0.003）。
重症监护病房急性肾衰竭患者存在显著的死亡危险因素，需要早期识别以便早期治疗。
