Mortality Predictors in Renal Transplant Recipients with Severe Sepsis and Septic Shock
Autor(a) principal: | |
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Data de Publicação: | 2014 |
Outros Autores: | , , , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Repositório Institucional da UNIFESP |
Texto Completo: | http://repositorio.unifesp.br/handle/11600/38447 http://dx.doi.org/10.1371/journal.pone.0111610 |
Resumo: | Introduction: the growing number of renal transplant recipients in a sustained immunosuppressive state is a factor that can contribute to increased incidence of sepsis. However, relatively little is known about sepsis in this population. the aim of this single-center study was to evaluate the factors associated with hospital mortality in renal transplant patients admitted to the intensive care unit (ICU) with severe sepsis and septic shock.Methods: Patient demographics and transplant-related and ICU stay data were retrospectively collected. Multiple logistic regression was conducted to identify the independent risk factors associated with hospital mortality.Results: A total of 190 patients were enrolled, 64.2% of whom received kidneys from deceased donors. the mean patient age was 51 +/- 13 years (males, 115 [60.5%]), and the median APACHE II was 20 (16-23). the majority of patients developed sepsis late after the renal transplantation (2.1 [0.6-2.3] years). the lung was the most common infection site (59.5%). Upon ICU admission, 16.4% of the patients had <= 1 systemic inflammatory response syndrome criteria. Among the patients, 61.5% presented with >= 2 organ failures at admission, and 27.9% experienced septic shock within the first 24 hours of ICU admission. the overall hospital mortality rate was 38.4%. in the multivariate analysis, the independent determinants of hospital mortality were male gender (OR = 5.9; 95% CI, 1.7-19.6; p = 0.004), delta SOFA 24 h (OR = 1.7; 95% CI, 1.2-2.3; p = 0.001), mechanical ventilation (OR = 30; 95% CI, 8.8-102.2; p<0.0001), hematologic dysfunction (OR = 6.8; 95% CI, 2.0-22.6; p = 0.002), admission from the ward (OR = 3.4; 95% CI, 1.2-9.7; p = 0.02) and acute kidney injury stage 3 (OR = 5.7; 95% CI, 1.9-16.6; p = 0.002).Conclusions: Hospital mortality in renal transplant patients with severe sepsis and septic shock was associated with male gender, admission from the wards, worse SOFA scores on the first day and the presence of hematologic dysfunction, mechanical ventilation or advanced graft dysfunction. |
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Carvalho, Monica Andrade de [UNIFESP]Freitas, Flavio Geraldo Rezende [UNIFESP]Tedesco-Silva Junior, Hélio [UNIFESP]Bafi, Antonio Tonete [UNIFESP]Machado, Flavia Ribeiro [UNIFESP]Pestana, Jose Osmar Medina [UNIFESP]Universidade Federal de São Paulo (UNIFESP)2016-01-24T14:38:10Z2016-01-24T14:38:10Z2014-11-04Plos One. San Francisco: Public Library Science, v. 9, n. 11, 10 p., 2014.1932-6203http://repositorio.unifesp.br/handle/11600/38447http://dx.doi.org/10.1371/journal.pone.0111610WOS000344402000078.pdf10.1371/journal.pone.0111610WOS:000344402000078Introduction: the growing number of renal transplant recipients in a sustained immunosuppressive state is a factor that can contribute to increased incidence of sepsis. However, relatively little is known about sepsis in this population. the aim of this single-center study was to evaluate the factors associated with hospital mortality in renal transplant patients admitted to the intensive care unit (ICU) with severe sepsis and septic shock.Methods: Patient demographics and transplant-related and ICU stay data were retrospectively collected. Multiple logistic regression was conducted to identify the independent risk factors associated with hospital mortality.Results: A total of 190 patients were enrolled, 64.2% of whom received kidneys from deceased donors. the mean patient age was 51 +/- 13 years (males, 115 [60.5%]), and the median APACHE II was 20 (16-23). the majority of patients developed sepsis late after the renal transplantation (2.1 [0.6-2.3] years). the lung was the most common infection site (59.5%). Upon ICU admission, 16.4% of the patients had <= 1 systemic inflammatory response syndrome criteria. Among the patients, 61.5% presented with >= 2 organ failures at admission, and 27.9% experienced septic shock within the first 24 hours of ICU admission. the overall hospital mortality rate was 38.4%. in the multivariate analysis, the independent determinants of hospital mortality were male gender (OR = 5.9; 95% CI, 1.7-19.6; p = 0.004), delta SOFA 24 h (OR = 1.7; 95% CI, 1.2-2.3; p = 0.001), mechanical ventilation (OR = 30; 95% CI, 8.8-102.2; p<0.0001), hematologic dysfunction (OR = 6.8; 95% CI, 2.0-22.6; p = 0.002), admission from the ward (OR = 3.4; 95% CI, 1.2-9.7; p = 0.02) and acute kidney injury stage 3 (OR = 5.7; 95% CI, 1.9-16.6; p = 0.002).Conclusions: Hospital mortality in renal transplant patients with severe sepsis and septic shock was associated with male gender, admission from the wards, worse SOFA scores on the first day and the presence of hematologic dysfunction, mechanical ventilation or advanced graft dysfunction.Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Hospital do RimUniversidade Federal de São Paulo, Unidade Transplante, Disciplina Nefrol, São Paulo, BrazilUniversidade Federal de São Paulo, Disciplina Anestesiol Dor & Terapia Intens, São Paulo, BrazilUniversidade Federal de São Paulo, Unidade Transplante, Disciplina Nefrol, São Paulo, BrazilUniversidade Federal de São Paulo, Disciplina Anestesiol Dor & Terapia Intens, São Paulo, BrazilWeb of Science10engPublic Library SciencePlos OneMortality Predictors in Renal Transplant Recipients with Severe Sepsis and Septic Shockinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleinfo:eu-repo/semantics/openAccessreponame:Repositório Institucional da UNIFESPinstname:Universidade Federal de São Paulo (UNIFESP)instacron:UNIFESPORIGINALWOS000344402000078.pdfapplication/pdf792602${dspace.ui.url}/bitstream/11600/38447/1/WOS000344402000078.pdf324497476675471bc660bf945d31c7cbMD51open accessTEXTWOS000344402000078.pdf.txtWOS000344402000078.pdf.txtExtracted texttext/plain47177${dspace.ui.url}/bitstream/11600/38447/2/WOS000344402000078.pdf.txtdac32082c00fd97ecb57a7d056d14d6dMD52open access11600/384472023-01-30 22:19:11.634open accessoai:repositorio.unifesp.br:11600/38447Repositório InstitucionalPUBhttp://www.repositorio.unifesp.br/oai/requestopendoar:34652023-01-31T01:19:11Repositório Institucional da UNIFESP - Universidade Federal de São Paulo (UNIFESP)false |
dc.title.en.fl_str_mv |
Mortality Predictors in Renal Transplant Recipients with Severe Sepsis and Septic Shock |
title |
Mortality Predictors in Renal Transplant Recipients with Severe Sepsis and Septic Shock |
spellingShingle |
Mortality Predictors in Renal Transplant Recipients with Severe Sepsis and Septic Shock Carvalho, Monica Andrade de [UNIFESP] |
title_short |
Mortality Predictors in Renal Transplant Recipients with Severe Sepsis and Septic Shock |
title_full |
Mortality Predictors in Renal Transplant Recipients with Severe Sepsis and Septic Shock |
title_fullStr |
Mortality Predictors in Renal Transplant Recipients with Severe Sepsis and Septic Shock |
title_full_unstemmed |
Mortality Predictors in Renal Transplant Recipients with Severe Sepsis and Septic Shock |
title_sort |
Mortality Predictors in Renal Transplant Recipients with Severe Sepsis and Septic Shock |
author |
Carvalho, Monica Andrade de [UNIFESP] |
author_facet |
Carvalho, Monica Andrade de [UNIFESP] Freitas, Flavio Geraldo Rezende [UNIFESP] Tedesco-Silva Junior, Hélio [UNIFESP] Bafi, Antonio Tonete [UNIFESP] Machado, Flavia Ribeiro [UNIFESP] Pestana, Jose Osmar Medina [UNIFESP] |
author_role |
author |
author2 |
Freitas, Flavio Geraldo Rezende [UNIFESP] Tedesco-Silva Junior, Hélio [UNIFESP] Bafi, Antonio Tonete [UNIFESP] Machado, Flavia Ribeiro [UNIFESP] Pestana, Jose Osmar Medina [UNIFESP] |
author2_role |
author author author author author |
dc.contributor.institution.none.fl_str_mv |
Universidade Federal de São Paulo (UNIFESP) |
dc.contributor.author.fl_str_mv |
Carvalho, Monica Andrade de [UNIFESP] Freitas, Flavio Geraldo Rezende [UNIFESP] Tedesco-Silva Junior, Hélio [UNIFESP] Bafi, Antonio Tonete [UNIFESP] Machado, Flavia Ribeiro [UNIFESP] Pestana, Jose Osmar Medina [UNIFESP] |
description |
Introduction: the growing number of renal transplant recipients in a sustained immunosuppressive state is a factor that can contribute to increased incidence of sepsis. However, relatively little is known about sepsis in this population. the aim of this single-center study was to evaluate the factors associated with hospital mortality in renal transplant patients admitted to the intensive care unit (ICU) with severe sepsis and septic shock.Methods: Patient demographics and transplant-related and ICU stay data were retrospectively collected. Multiple logistic regression was conducted to identify the independent risk factors associated with hospital mortality.Results: A total of 190 patients were enrolled, 64.2% of whom received kidneys from deceased donors. the mean patient age was 51 +/- 13 years (males, 115 [60.5%]), and the median APACHE II was 20 (16-23). the majority of patients developed sepsis late after the renal transplantation (2.1 [0.6-2.3] years). the lung was the most common infection site (59.5%). Upon ICU admission, 16.4% of the patients had <= 1 systemic inflammatory response syndrome criteria. Among the patients, 61.5% presented with >= 2 organ failures at admission, and 27.9% experienced septic shock within the first 24 hours of ICU admission. the overall hospital mortality rate was 38.4%. in the multivariate analysis, the independent determinants of hospital mortality were male gender (OR = 5.9; 95% CI, 1.7-19.6; p = 0.004), delta SOFA 24 h (OR = 1.7; 95% CI, 1.2-2.3; p = 0.001), mechanical ventilation (OR = 30; 95% CI, 8.8-102.2; p<0.0001), hematologic dysfunction (OR = 6.8; 95% CI, 2.0-22.6; p = 0.002), admission from the ward (OR = 3.4; 95% CI, 1.2-9.7; p = 0.02) and acute kidney injury stage 3 (OR = 5.7; 95% CI, 1.9-16.6; p = 0.002).Conclusions: Hospital mortality in renal transplant patients with severe sepsis and septic shock was associated with male gender, admission from the wards, worse SOFA scores on the first day and the presence of hematologic dysfunction, mechanical ventilation or advanced graft dysfunction. |
publishDate |
2014 |
dc.date.issued.fl_str_mv |
2014-11-04 |
dc.date.accessioned.fl_str_mv |
2016-01-24T14:38:10Z |
dc.date.available.fl_str_mv |
2016-01-24T14:38:10Z |
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Plos One. San Francisco: Public Library Science, v. 9, n. 11, 10 p., 2014. |
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http://repositorio.unifesp.br/handle/11600/38447 http://dx.doi.org/10.1371/journal.pone.0111610 |
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1932-6203 |
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WOS000344402000078.pdf |
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10.1371/journal.pone.0111610 |
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Plos One. San Francisco: Public Library Science, v. 9, n. 11, 10 p., 2014. 1932-6203 WOS000344402000078.pdf 10.1371/journal.pone.0111610 WOS:000344402000078 |
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http://repositorio.unifesp.br/handle/11600/38447 http://dx.doi.org/10.1371/journal.pone.0111610 |
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