Acute renal injury in patients with severe sepsis: prognostic factors <br><b>Abstract in English]</b>

Abstract

AIMS: To investigate the determinants of prognosis in patients with severe sepsis and acute renal failure. METHODS: We included all patients older than 18 years admitted to the intensive care unit of University Hospital of Londrina (Paraná state) between May 2007 and June 2008 with a diagnosis of severe sepsis or septic shock. RESULTS: We analyzed 67 patients, whose average age was 61±18 years; 47 (70.1%) had acute renal failure and 18 (26.9%) required dialysis. Mortality was higher in patients with acute renal failure (85.1%) compared with patients without acute renal failure (35.0%, p less than 0.001). There was need for mechanical ventilation in 53 (79.1%) patients and vasoactive drugs in 51 (76.1%) patients. Risk factors that were associated with higher mortality in the bivariate analysis were the APACHE II score (p = 0.02), SOFA (p = 0.03), vasoactive drugs (p less than 0.01) and mechanical ventilation (p = 0.01). In multivariate analysis, vasoactive drugs remained significant, with OR of 25.33 (95% CI 3.21-199.69, p = 0.002). CONCLUSIONS: Acute renal failure was a common occurrence in patients with sepsis, as part of a framework of multiple organ systems and, particularly in patients with septic shock. Acute renal failure was associated with increased likelihood of death in these severely ill patients. Use of vasoactive drugs was the only risk factor for mortality in patients with sepsis and acute renal failure which remained in the multivariate analysis. These results point to the importance of early treatment of severe sepsis in time to prevent progression to septic shock and renal failure.