Risk factors for death among critically ill patients with acute renal failure.

CONTEXT AND OBJECTIVE

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.

DESIGN AND SETTING

Retrospective cohort at the intensive care unit of Hospital Universitário Walter Cantídio, Fortaleza.

METHODS

Survivors and non-survivors were compared. Univariate and multivariate analyses were performed to establish risk factors for death.

RESULTS

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).

CONCLUSIONS

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.