Liaño F, Pascual J
Hospital Ramón y Cajal, Servicio de Nefrología, Madrid, Spain.
Semin Nephrol. 1998 Sep;18(5):541-50.
Although patients with acute renal failure (ARF) are now older and sicker than in the past, mortality remains constant or even slightly lower, which suggests a better management of the syndrome. Several clinical conditions, mainly assisted respiration, hypotension, oliguria, coma and jaundice, have a detrimental effect on outcome. Previous health status, original disease, a hospital and/or ICU start of the ARF, and age of the patient also seem to affect outcome of these patients. ARF observed in the ICU setting has a poorer prognosis than the ARF treated in other hospital areas. This is because of the higher number of associated organ failures observed in the ICU. Estimation of outcome could be done either using specific ARF or general ICU score systems. They allow risk stratification of the patients, and some of them give an individual prognosis that at present should not be used for a withdrawal decision. Functional outcome of ARF is usually good, although some patients need to be maintained on chronic dialysis.
尽管与过去相比，急性肾衰竭（ARF）患者现在年龄更大、病情更重，但死亡率保持稳定甚至略有下降，这表明对该综合征的管理有所改善。几种临床情况，主要是辅助呼吸、低血压、少尿、昏迷和黄疸，对预后有不利影响。既往健康状况、原发病、ARF开始于医院和/或重症监护病房（ICU）以及患者年龄似乎也会影响这些患者的预后。在ICU环境中观察到的ARF比在其他医院区域治疗的ARF预后更差。这是因为在ICU中观察到的相关器官衰竭数量更多。可以使用特定的ARF评分系统或通用的ICU评分系统来评估预后。它们可以对患者进行风险分层，其中一些还能给出个体预后，但目前不应将其用于撤机决策。ARF的功能预后通常较好，尽管有些患者需要长期进行透析治疗。
