A Prospective, Multicenter Study of the Epidemiology, Management, and Outcome of Severe Acute Renal Failure in a “Closed” ICU System

Cole, Louise; Bellomo, Rinaldo; Silvester, William; Reeves, John H.

doi:10.1164/ajrccm.162.1.9907016

Cited by 192 publications

(117 citation statements)

References 21 publications

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“…It is a well-known fact that sepsis is an important risk factor for the development of ARF, and mortality in this specific subgroup of ARF patients is considerably higher than in others (2,12,20,23). There are however surprisingly few data on risk factors for the development of ARF in sepsis patients.…”

Section: Discussionmentioning

confidence: 96%

mentioning

confidence: 99%

“…Sepsis is also a well-known risk factor for the development of ARF, and 35 to 50% of ARF cases in the ICU can be attributed to sepsis (2,12,20,23). Mortality in this subgroup of patients is considerably higher than in other subgroups of ARF (2,20,23).Despite these considerations, there are to the best of our knowledge hardly any data concerning risk factors associated with the development of ARF in patients with sepsis. Our own group found in 1993 that sepsis patients who developed ARF had more associated organ failure, more need for vasoactive therapy, and had a lower central venous pressure (CVP), despite more aggressive fluid therapy, compared with sepsis patients without ARF (31).…”

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confidence: 99%

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Acute Renal Failure in Patients with Sepsis in a Surgical ICU

Hoste¹,

Lameire²,

Vanholder³

et al. 2003

Journal of the American Society of Nephrology

379

234

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Abstract. Acute renal failure (ARF) is a common complication in intensive care unit (ICU) patients. Although there are several reports on outcome of septic patients with ARF, there are no data regarding predisposing factors for ARF. Therefore, the incidence of ARF was investigated in 185 sepsis patients admitted in a surgical ICU during a 16-mo period. Variables predisposing to ARF on day 1 of sepsis were evaluated with univariate and multivariable analyses. APACHE II and SOFA scores were compared during a 14-d period. Additionally, the impact of organ failure on mortality was evaluated. ARF developed in 16.2% of the patients, and 70.0% of these needed renal replacement therapy (RRT). Patients with ARF were more severely ill and had a higher mortality. Remarkably, serum creatinine was already increased on day 1. Creatinine Ͼ 1 mg/dl and pH Ͻ 7.30, both on day 1 of sepsis, were independently associated with ARF. Age, need for vasoactive therapy, mechanical ventilation, and RRT, but not ARF itself, were associated with mortality. In conclusion, ARF was a frequent complication in sepsis. Sepsis patients with ARF were more severely ill and had a higher mortality. Need for RRT was independently associated with mortality. A simple risk model for ARF, on basis of two readily available parameters on day 1 of sepsis, was developed. This model allows initiating specific therapeutic measures earlier in the course of sepsis, hopefully resulting in a lower incidence of ARF and needi for RRT, thereby lowering mortality.Acute renal failure (ARF) is a common complication in patients admitted to the intensive care unit (ICU). Numerous causes are responsible for the development of ARF (1); moreover, ARF has often a multi-factorial etiology in critically ill patients. The relative importance of factors contributing to ARF will be different depending on the underlying pathology and patient characteristics. A patient population of young trauma patients developing ARF can probably not be compared with older patients with ischemic and congestive heart disease developing ARF after cardiac surgery. The large differences in mortality for patients with ARF, as reported in recent trials (varying between 28 and 83%) can possibly be explained by differences in patient population (2-25). On the other hand, the relatively stable mortality of patients with ARF over the past decades, despite advances in critical and renal care, is attributed to the changing pattern of associated pathology and patient populations (26 -29).Analysis of a well-described subgroup of ICU patients (e.g., patients after cardiac surgery or sepsis patients) can reveal more precise information concerning the epidemiology and risk factors for development of ARF.Sepsis is a common condition with an annual death toll in the United States comparable to that of acute myocardial infarction (30). Sepsis is also a well-known risk factor for the development of ARF, and 35 to 50% of ARF cases in the ICU can be attributed to sepsis (2,12,20,23). Mortality in this subgroup of patients...

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Section: Discussionmentioning

confidence: 96%

mentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

Acute Renal Failure in Patients with Sepsis in a Surgical ICU

Hoste¹,

Lameire²,

Vanholder³

et al. 2003

Journal of the American Society of Nephrology

379

234

View full text Add to dashboard Cite

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“…Acute kidney injury (AKI) is a common clinical problem in critically ill patients [1][2][3]. It has quite high prevalence among the intensive care unit (ICU) patients varying between 30-50% with an attributed mor-tality rate varying between 28-90% [1][2][3][4].…”

Section: Introductionmentioning

confidence: 99%

“…It has quite high prevalence among the intensive care unit (ICU) patients varying between 30-50% with an attributed mor-tality rate varying between 28-90% [1][2][3][4]. Approximately 50% of all AKI is considered to be associated with sepsis and 15-20% of all patients admitted to ICUs are septic AKI patients [2].…”

Section: Introductionmentioning

confidence: 99%

The Use of Plasma and Urine Neutrophil Gelatinase Associated Lipocalin (NGAL) and Cystatin C in Early Diagnosis of Septic Acute Kidney Injury in Critically Ill Patients

et al. 2013

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Abstract. AIM:To assess and compare the roles of plasma and urine concentrations of neutrophil gelatinase associated lipocalin (NGAL) and Cystatin C for early diagnosis of septic acute kidney injury (AKI) in adult critically ill patients. METHODS: Patients were divided into three groups as sepsis-non AKI, sepsis-AKI and non sepsis-non AKI. Plasma samples for NGAL and Cystatin C were determined on admission and on alternate days and urinary samples were collected for every day until ICU discharge. RESULTS: One hundred fifty one patients were studied; 66 in sepsis-non AKI, 63 in sepsis-AKI, 22 in non-sepsis-non-AKI groups. Although plasma NGAL performed less well (AUC 0.44), urinary NGAL showed significant discrimination for AKI diagnosis (AUC 0.80) with a threshold value of 29.5 ng/ml (88% sensitivity, 73% specificity). Both plasma and urine Cystatin C worked well for the diagnosis of AKI (AUC 0.82 and 0.86, thresholds 1.5 and 0.106 mg/L respectively). CONCLUSION: Plasma and urinary Cystatin C and urinary NGAL are useful markers in predicting AKI in septic critically ill patients. Plasma NGAL raises in patients with sepsis in the absence of AKI and should be used with caution as a marker of AKI in septic ICU patients.

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