Acute renal injury in patients with severe sepsis: prognostic factors Abstract in English]
Autor(a) principal: | |
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Data de Publicação: | 2012 |
Outros Autores: | , , , , , , , |
Tipo de documento: | Artigo |
Idioma: | por eng |
Título da fonte: | Scientia Medica (Porto Alegre. Online) |
Texto Completo: | https://revistaseletronicas.pucrs.br/scientiamedica/article/view/10804 |
Resumo: | 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. |
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Acute renal injury in patients with severe sepsis: prognostic factors Abstract in English]Insuficiência renal aguda em pacientes com sepse grave: fatores prognósticosSEPSISRENAL INDUFFICIENCYMULTIPLE ORGAN FAILUREMORTALITYRISK FACTORS.SEPSEINSUFICIÊNCIA RENALFALÊNCIA DE MÚLTIPLOS ÓRGÃOSMORTALIDADEFATORES DE RISCO.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.OBJETIVOS: Verificar os fatores determinantes de prognóstico nos pacientes com sepse grave e insuficiência renal aguda. MÉTODOS: Foram incluídos todos os pacientes maiores que 18 anos internados na unidade de cuidados intensivos do Hospital Universitário de Londrina (estado do Paraná) entre maio de 2007 e junho de 2008 com diagnóstico de sepse grave ou choque séptico. RESULTADOS: Foram analisados 67 pacientes, cuja média de idade foi de 61±18 anos, sendo que 47 (70,1%) apresentaram insuficiência renal aguda e 18 (26,9%) necessitaram diálise. A mortalidade foi maior nos pacientes com insuficiência renal aguda (85,1%) quando comparada com a dos pacientes sem insuficiência renal aguda (35,0%; p menor que 0,001). Houve necessidade de ventilação mecânica em 53 (79,1%) pacientes e de drogas vasoativas em 51 (76,1%) pacientes. Os fatores de risco que se associaram com maior mortalidade pela análise bivariada foram o escore APACHE II (p=0,02), SOFA (p=0,03), uso de drogas vasoativas (p menor que 0,01) e uso de ventilação mecânica (p=0,01). Na análise multivariada o uso de drogas vasoativas manteve a significância, com OR de 25,33 (IC 95% 3,21-199,69; p=0,002). CONCLUSÕES: A insuficiência renal aguda foi ocorrência comum nos pacientes com sepse, fazendo parte de um quadro de disfunção de múltiplos órgãos e sistemas, particularmente nos pacientes com diagnóstico de choque séptico, estando associada a aumento da probabilidade de morte nesses pacientes graves. O uso de drogas vasoativas foi o único fator de risco para mortalidade em pacientes com sepse e insuficiência renal aguda que se manteve na análise multivariada. Estes resultados apontam para a importância do tratamento precoce dos quadros de sepse grave a tempo de prevenir a evolução para choque séptico e para insuficiência renal.Editora da PUCRS - ediPUCRS2012-08-07info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionapplication/pdfapplication/pdfhttps://revistaseletronicas.pucrs.br/scientiamedica/article/view/10804Scientia Medica; Vol. 22 No. 3 (2012); 138-141Scientia Medica; v. 22 n. 3 (2012); 138-1411980-61081806-5562reponame:Scientia Medica (Porto Alegre. Online)instname:Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS)instacron:PUC_RSporenghttps://revistaseletronicas.pucrs.br/scientiamedica/article/view/10804/8181https://revistaseletronicas.pucrs.br/scientiamedica/article/view/10804/8182Okamoto, Thábata YaeduDias, Jéssica Christiane YoshiharaTaguti, PriscilaSacon, Maria FernandaKauss, Ivanil Aparecida MoroCarrilho, Claudia Maria Dantas de MaioCardoso, Lucienne Tibery QueirozGrion, Cintia Magalhães CarvalhoMatsuo, Tiemiinfo:eu-repo/semantics/openAccess2013-07-15T18:40:59Zoai:ojs.revistaseletronicas.pucrs.br:article/10804Revistahttps://revistaseletronicas.pucrs.br/scientiamedica/PUBhttps://revistaseletronicas.pucrs.br/scientiamedica/oaiscientiamedica@pucrs.br || editora.periodicos@pucrs.br1980-61081806-5562opendoar:2013-07-15T18:40:59Scientia Medica (Porto Alegre. Online) - Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS)false |
dc.title.none.fl_str_mv |
Acute renal injury in patients with severe sepsis: prognostic factors Abstract in English] Insuficiência renal aguda em pacientes com sepse grave: fatores prognósticos |
title |
Acute renal injury in patients with severe sepsis: prognostic factors Abstract in English] |
spellingShingle |
Acute renal injury in patients with severe sepsis: prognostic factors Abstract in English] Okamoto, Thábata Yaedu SEPSIS RENAL INDUFFICIENCY MULTIPLE ORGAN FAILURE MORTALITY RISK FACTORS. SEPSE INSUFICIÊNCIA RENAL FALÊNCIA DE MÚLTIPLOS ÓRGÃOS MORTALIDADE FATORES DE RISCO. |
title_short |
Acute renal injury in patients with severe sepsis: prognostic factors Abstract in English] |
title_full |
Acute renal injury in patients with severe sepsis: prognostic factors Abstract in English] |
title_fullStr |
Acute renal injury in patients with severe sepsis: prognostic factors Abstract in English] |
title_full_unstemmed |
Acute renal injury in patients with severe sepsis: prognostic factors Abstract in English] |
title_sort |
Acute renal injury in patients with severe sepsis: prognostic factors Abstract in English] |
author |
Okamoto, Thábata Yaedu |
author_facet |
Okamoto, Thábata Yaedu Dias, Jéssica Christiane Yoshihara Taguti, Priscila Sacon, Maria Fernanda Kauss, Ivanil Aparecida Moro Carrilho, Claudia Maria Dantas de Maio Cardoso, Lucienne Tibery Queiroz Grion, Cintia Magalhães Carvalho Matsuo, Tiemi |
author_role |
author |
author2 |
Dias, Jéssica Christiane Yoshihara Taguti, Priscila Sacon, Maria Fernanda Kauss, Ivanil Aparecida Moro Carrilho, Claudia Maria Dantas de Maio Cardoso, Lucienne Tibery Queiroz Grion, Cintia Magalhães Carvalho Matsuo, Tiemi |
author2_role |
author author author author author author author author |
dc.contributor.author.fl_str_mv |
Okamoto, Thábata Yaedu Dias, Jéssica Christiane Yoshihara Taguti, Priscila Sacon, Maria Fernanda Kauss, Ivanil Aparecida Moro Carrilho, Claudia Maria Dantas de Maio Cardoso, Lucienne Tibery Queiroz Grion, Cintia Magalhães Carvalho Matsuo, Tiemi |
dc.subject.por.fl_str_mv |
SEPSIS RENAL INDUFFICIENCY MULTIPLE ORGAN FAILURE MORTALITY RISK FACTORS. SEPSE INSUFICIÊNCIA RENAL FALÊNCIA DE MÚLTIPLOS ÓRGÃOS MORTALIDADE FATORES DE RISCO. |
topic |
SEPSIS RENAL INDUFFICIENCY MULTIPLE ORGAN FAILURE MORTALITY RISK FACTORS. SEPSE INSUFICIÊNCIA RENAL FALÊNCIA DE MÚLTIPLOS ÓRGÃOS MORTALIDADE FATORES DE RISCO. |
description |
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. |
publishDate |
2012 |
dc.date.none.fl_str_mv |
2012-08-07 |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
https://revistaseletronicas.pucrs.br/scientiamedica/article/view/10804 |
url |
https://revistaseletronicas.pucrs.br/scientiamedica/article/view/10804 |
dc.language.iso.fl_str_mv |
por eng |
language |
por eng |
dc.relation.none.fl_str_mv |
https://revistaseletronicas.pucrs.br/scientiamedica/article/view/10804/8181 https://revistaseletronicas.pucrs.br/scientiamedica/article/view/10804/8182 |
dc.rights.driver.fl_str_mv |
info:eu-repo/semantics/openAccess |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
application/pdf application/pdf |
dc.publisher.none.fl_str_mv |
Editora da PUCRS - ediPUCRS |
publisher.none.fl_str_mv |
Editora da PUCRS - ediPUCRS |
dc.source.none.fl_str_mv |
Scientia Medica; Vol. 22 No. 3 (2012); 138-141 Scientia Medica; v. 22 n. 3 (2012); 138-141 1980-6108 1806-5562 reponame:Scientia Medica (Porto Alegre. Online) instname:Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS) instacron:PUC_RS |
instname_str |
Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS) |
instacron_str |
PUC_RS |
institution |
PUC_RS |
reponame_str |
Scientia Medica (Porto Alegre. Online) |
collection |
Scientia Medica (Porto Alegre. Online) |
repository.name.fl_str_mv |
Scientia Medica (Porto Alegre. Online) - Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS) |
repository.mail.fl_str_mv |
scientiamedica@pucrs.br || editora.periodicos@pucrs.br |
_version_ |
1809101749994127360 |