Vega J, Borja H, Videla C, Aldunate T, Clavero R, Echeverría C, Torres H, Varela C, Vilches G, Díaz R
Sección de Nefrología y Diálisis, Unidad de Cuidados Intensivos Hospital Dr. Gustavo Fricke, Viña del Mar, Chile.
Rev Med Chil. 1996 Aug;124(8):938-46.
The purpose of this prospective study was to determine whether the course and prognosis of acute renal failure (ARF) in patients with and without sepsis are different. Two hundred fifty-two (8%) of 3086 consecutive patients admitted to a medical-surgical intensive care unit (ICU) developed ARE. One hundred forty-nine (59%) were septic and 103 (41%) were non-septic. No differences were found between groups regarding the incidence of oliguria, hyperkalemia, hypercatabolism, gastrointestinal bleeding, duration of oligria and renal deficit, severity of axotemia, dialysis requirements and duration of stay in the hospital. There were statistically significant differences between septic and non septic patients with respect of hyponatremia (67.8 vs 54.4%, p < 0.04), respiratory failure (68 vs 54%, p < 0.04), and thrombocytopenia (64 vs 48%, p < 0.02). Mortality in septic patients was higher than in non-septics (56 vs 42.7%, p < 0.009). Factors associated with increased mortality in ARF septic patients were respiratory failure, metabolic acidosis and oliguria while in the non-septics they were hepatic dysfunction, hyperkalemia, respiratory failure and infection acquired during the course of renal failure. We conclude that ARF developing in septic patients has a higher mortality than that of non-septic patients, whereas the incidence of hypercatabolism and oliguria was not different between both groups.
这项前瞻性研究的目的是确定伴有和不伴有脓毒症的急性肾衰竭（ARF）患者的病程和预后是否存在差异。在内外科重症监护病房（ICU）收治的3086例连续患者中，有252例（8%）发生了急性肾衰竭。其中149例（59%）为脓毒症患者，103例（41%）为非脓毒症患者。两组在少尿、高钾血症、高分解代谢、胃肠道出血、少尿持续时间和肾功能缺损、氮质血症严重程度、透析需求及住院时间方面未发现差异。脓毒症患者和非脓毒症患者在低钠血症（67.8%对54.4%，p<0.04）、呼吸衰竭（68%对54%，p<0.04）和血小板减少症（64%对48%，p<0.02）方面存在统计学显著差异。脓毒症患者的死亡率高于非脓毒症患者（56%对42.7%，p<0.009）。ARF脓毒症患者死亡率增加的相关因素为呼吸衰竭、代谢性酸中毒和少尿，而非脓毒症患者为肝功能障碍、高钾血症、呼吸衰竭和肾衰竭病程中获得的感染。我们得出结论，脓毒症患者发生的ARF死亡率高于非脓毒症患者，而两组之间高分解代谢和少尿的发生率并无差异。
