急性肾衰竭预后及其影响因素的研究

目的探讨急性肾衰竭（ARF）预后及影响因素。方法回顾性分析1998年1月至2006年12月收治的398例ARF患者的临床资料，根据患者的病因、年龄、有无基础疾病、是否行肾脏替代治疗、是否合并多脏器功能衰竭分析ARF的预后。结果并发严重心脑血管疾病、严重感染、恶性肿瘤者预后较差；有基础疾病、老年、未行肾脏替代治疗、合并其他脏器功能衰竭者预后差，与对照组比较，差异有统计学意义（P〈0．05）。结论ARF的预后受多种因素的影响，临床医师应予以充分透析治疗，防治并发症，以改善预后。     

影响急性肾功能衰竭患者住院病死率与肾脏预后的危险因素分析

目的：探讨影响急性肾功能衰竭（ARF）住院患者病死率与肾脏预后的危险因素,以提高ARF的治疗水平。方法：通过对我院近10年422例ARF患者临床资料的回顾性研究,应用二值多元Logistic回归和线性回归分析对影响ARF患者病死率与肾脏预后的危险因素进行分析。结果：在32项观察因素中发现低血压、昏迷、消化道出血、呼吸衰竭、肝衰竭、心力衰竭、肿瘤、败血症是患者病死率相关的危险因素;肿瘤、呼吸衰竭、心力衰竭为影响肾功能恢复的危险因素。结论：上述危险因素是影响ARF患者病死率、导致肾功能难以恢复的原因,并与患者的近期预后密切相关。     

320例急性肾功能衰竭患者的临床分析

目的 探讨急性肾功能衰竭（ARF）住院患者的病因、预后及影响预后的因素。 方法 回顾性研究我院2003年12月至2006年12月期间急性肾功能衰竭患者的临床资料。 结果 观察期间住院患者共108 744例次，其中ARF患者320例，老年ARF患者135例，占42.2%。ARF主要病因为感染、心力衰竭和药物。ARF患者总体病死率为31.9%，老年人病死率较高。Logistic回归分析显示心力衰竭、呼吸衰竭及恶性肿瘤是与预后相关的危险因素。接受肾替代治疗组患者病死率低于保守治疗组（23.2％比35.6％，P < 0.05）。 结论 住院患者中ARF的发生率、病死率高，替代治疗组预后较好。     

急性肾衰竭100例临床分析

目的 总结急性肾衰竭(ARF)的病因、临床特点以及影响预后的因素。方法 回顾性分析本科1997年1月至2004年12月收治的100例ARF患者的临床和病理资料。结果 100例ARF患者中,男性63例,女性37例,平均年龄(48．14±17．80)岁。肾前性ARF20例,感染 特别是急性胃肠炎占很大比重。肾性ARF 70例,其中急性间质性肾炎(AIN)9例(12．9％),急性 肾小管坏死(ATN)33例(47．1％),小球及微血管病变28例(40．0％);药物导致的肾损害33例 (47．1％),包括AIN 7例及ATN 26例;35例行肾活检。肾后性ARF10例,病因为妇科、泌尿道、 胃肠道肿瘤和结石。病因分布在3个年龄组间无显著差异。老年组的Scr值、Hb和红细胞比容 (Hct)均低于中年组,而ATN-ISI评分值、存在高血压和肾脏病史的比例高于中年组和青年组。 少尿、血尿、蛋白尿、GFR等参数在3组间无显著差异。本研究中死亡5例(病死率5％),57例治 愈,29例好转,9例无效。单因素分析显示,年龄、蛋白尿、血清白蛋白、Hb、Hct、器官衰竭的数 目、ATN-ISI评分是影响预后的因素。多因素Logistic回归分析显示,年龄和器官衰竭的数目是影 响病死率的因素。结论 急性胃肠炎和肾毒性药物导致的ARF需要引起关注。早期诊断有助于 ARF的治愈,提高存活率。在已经进展到ARF阶段后,要注意预防并发症特别是多脏器功能不 全综合征(NODS)的发生。     

50例急性脑血管病并发多脏器功能衰竭的临床观察

目的探讨急性脑血管病并发多脏器功能衰竭的临床观察。方法对我院50例急性脑血管并发多脏器功能衰竭患者的临床资料进行回顾性分析。结果脑出血并发MOF的发生率及病死率明显高于脑梗死（P〈0.05）。年龄越大、原有基础疾病多者更易并发MOF。死亡率与脏器衰竭的数目成正比。结论急性脑血管病并发MOF病情严重,应注意早发现、积极预防,并采取综合治疗措施,以减少病死率。     

急性肾衰竭伴多脏器功能障碍综合征临床特征分析

目的：了解急性肾衰竭（ARF）伴多脏器功能障碍综合征（MODS）发病情况及临床特征。方法：对2003年1月~2007年12月间住院的ARF患者进行回顾性分析。结果：伴MODS的ARF多见于老年,发病率占总ARF的62.3%,病死率45.5%;随着功能障碍脏器数量的增多,ARF病死率明显升高。引起伴MODS的ARF的原因中以感染性疾病、休克、严重创伤、外科大手术后（以胆道疾病、恶性肿瘤手术）多见。结论：MODS是影响疾病预后的重要因素,伴MODS的ARF多见于老年且发生比例高,病死率亦高,对于伴MODS的ARF患者应进行早期预防性及充分透析治疗,以改善ARF的预后。     

重症急性胰腺炎合并急性肾功能衰竭54例临床分析

目的分析重症急性胰腺炎（SAP）合并急性肾功能衰竭（ARF）的临床特点及其预防和治疗。方法回顾分析南京军区南京总医院1997年1月至2005年4月收治的503例SAP中合并ARF的54例病人的临床资料，并用直线回归（逐步回归）方法，对影响SAP合并ARF的发生率及病死率的相关因素进行分析。结果SAP合并ARF的发生率为10．7％，病人的年龄、SIRS（全身炎症反应综合征）持续时间、病情严重程度（APACHEⅡ评分、CT评分）、ARDS（急性呼吸窘迫综合征）、MODS（多器官功能障碍综合征）、ACS（腹腔间室综合征）、感染及局部并发症等因素对ARF的发生有显著的影响；54例中，死亡18例（33．3％），同时合并ARDS和MODS是增加病人病死率的重要原因。是否伴有胰周感染对病人的病死率影响不显著。结论早期液体复苏、控制病情发展、维护重要脏器功能及积极有效的引流是预防SAP并发ARF，改善预后的重要手段。     

脓毒症的急性肾损伤

脓毒症是危重病患者的常见病因或并发症，也是大家熟知的引起急性肾损伤（AKI）和多脏器功能障碍综合征（MODS）的常见危险因素。急性肾功能衰竭（ARF）发生率在一般脓毒症患者约为19％；在重度脓毒症约为23％；在血培养阳性的脓毒症休克者可高达51％。ARF并发脓毒症的病死率高达70％，明显高于无并发脓毒症的45％。因此，研究并了解AKI和脓毒症的相互关系和作用机制，将有助于降低脓毒症时AKI的高发病率以及相关的高器官衰竭率和病死率。     

医院获得性急性肾衰竭的临床分析

目的：探讨医院获得性急性肾衰竭（hospital-acquired acute renal failure,HA-ARF）在流行病学、病因学和预后等方面的临床特点.方法：搜集近10年来住院患者HA-ARF的临床资料,分析其病因、病死率及预后;并与同期社区获得性急性肾衰竭（community-acquired acute renal failure,CA-ARF）患者的临床资料进行比较.结果：76例HA-ARF中57.2%是外科系统患者,其中药物相关性ARF占47.3%,手术相关性ARF占28.9%,感染相关性ARF占23.7%,合并多器官功能障碍综合征（MODS）占21.1%,HA-ARF病死率55.3%,年龄、ICU患者、机械通气、少尿、MODS与预后相关.结论：HA-ARF主要病因是药物、手术、感染,预后差,病死率高.     

急性肾损伤诊断与分类专家共识

近几十来．临床和基础的研究工作者们针对急性肾功能衰竭（ARF）进行了广泛的研究，尽管我们在该疾病的生理和发病机制方面都取得了长足的进步，但如何将这些知识用于临床，改进ARF患者预后方面的工作却做得十分有限。ARF是由多种病因导致、可发生在各种临床情况之下（儿童或成人、门诊或住院、ICU或非ICU患者）的一种复杂的肾功能紊乱，其临床表现既可以是血肌酐水平的轻微升高，也可以是无尿性肾功能衰竭。     

Acute renal failure in an intensive care unit in India--prognostic factors and outcome

We prospectively analyzed 70 consecutive patients who developed acute renal failure (ARF) in the intensive care unit (ICU) during a six year period to define prognostic factors and outcome. Age, sex, preexisting chronic diseases, systemic infections, number of organs failing during the disease course, need and mode of renal replacement therapy (RRT), and length of stay in ICU were recorded. Analysis of factors in survivors (n=7, Gp A) and nonsurvivors (n=63, Gp B) was done by univariate and multivariate analysis. The mean age of patients was 28.6 years. Forty nine (70%) patients developed ARF following surgery, whereas 21 (30%) developed ARF in a medical setting. Cardiovascular surgery (39) and pancreatic surgery (7) were important causes in the surgical group, whereas in the medical group acute pancreatitis (11) was the main causative factor. One patient had ARF only, while in the rest, other organs were also involved. In more than 80% of these patients, organ failure and sepsis were present before the onset of ARF. Fifty two (74.3%) patients required dialytic support. The overall mortality was 90%. Number of organs failing, (1.5 +/-9 in Gp A vs 3.6 +/- 8 in Gp B), presence of systemic infection (1 in Gp A vs 55 in Gp B), prolonged stay in ICU (3.7 +/- 1.1 days in Gp A vs 8.0 +/- 5.4 in Gp B) and need for RRT (2 in Gp A vs 50 in Gp B) correlated with the mortality. Using multiple logistic regression analysis, only multiple organ failure (3 or more) correlated with the mortality. We conclude that multiple organ failure is a poor prognostic factor in patients with ARF in the setting of the ICU.     

Factors associated with mortality in acute renal failure (ARF) in children

Objective: To assess the factors that affect the mortality in acute renal failure (ARF) in children. Patients and methods: We studied 149 patients with ARF and described the findings by age, gender, pathophysiological mechanism of renal damage, and type of renal damage, which can be oligoanuric and/or septic. We used multiple logistic analysis, Cox analysis for survival, and Kaplan–Meier curves. Results: The male/female ratio was 91/58. The most affected age groups were newborns (44.3%) and infants (37.6%). The ARF mechanism was ischemic in 87 cases (58%) and the most frequent clinical type was nonoliguric in 118 cases (79.2%). In the multiple logistic regression analysis, only oliguria (P=0.07) and age group (P=0.049) were associated with mortality. In the survival analysis using the Cox method, oliguria (P=0.003) and sepsis (P=0.03) were associated with mortality. The survival curves showed that the cumulative probability of dying in the first 10, 20, or 40 days after the event was 75, 70, and 45% respectively. When oliguria was present, the survival at day 10 was 47% and when sepsis was present it was 68%. Conclusion: Oliguria, age, and sepsis are factors associated with mortality in children with ARF.     

Sepsis and SOFA score: related outcome for critically ill renal patients

AIMS: To evaluate the influence of sepsis in critically ill patients with acute renal failure (ARF), and to analyze the value of the sequential organ failure assessment (SOFA) score for assessing the morbidity and related mortality of these patients. MATERIAL AND METHODS: A prospective observational study developed in a medical intensive care unit (ICU) of a tertiary care university hospital. Data were collected from January 1, 2001 - July 31, 2002. The inclusion criterion was either a creatinine plasma level > or = 2 mg/dl on ICU admission or increases > or = 30% from its initial value. Sepsis was evaluated at the time of study inclusion, and patients were distributed into 2 groups (septic and nonseptic patients). RESULTS: Two hundred patients with ARF were prospectively enrolled in the study (91 (45.5%) septic and 109 (54.5%) nonseptic patients). Median age was 68 years in septic patients and 72 in nonseptic ones while the percentage of males in both groups was 66% vs 69%, respectively. Septic patients showed more organ failures and more respiratory, cardiovascular and coagulation failures at the time of study admission as well as a worse mean SOFA score during the first 4 days after inclusion (p < 0.01). Mortality rate at the ICU was significantly higher in the septic group when compared to the nonseptic one (55% vs 19.3%, OR = 2.21 (1.65 - 2.97)). Using stepwise logistic regression, acute tubular necrosis and oliguria in septic patients as well as cardiovascular failure (evaluated by SOFA score) in nonseptic patients were identified as independent risk factors for mortality. CONCLUSIONS: Septic and nonseptic ICU patients with ARF have an increased risk of ICU mortality depending on the type of organ failure. Although SOFA score does not predict outcome, it is a useful tool to categorize these patients and to describe a sequence of complications in critically ill patients.     

Outcome from intensive care. II. A 5-year study of 1308 patients: short-term outcome

All patients (n = 1308) admitted to a multidisciplinary intensive care unit (ICU) during a 5-year period (1979-83) were followed prospectively. The in-unit mortality was 18% and the in-hospital mortality (mortality during ICU-stay plus mortality during the ensuing hospital stay) was 29%. Increasing age was associated with increasing in-hospital mortality, up to 40% mortality rate in patients aged 80 years and older. Using multiple logistic regression analyses, prognostic factors for mortality were identified. Risk factors for death in the ICU included age, cardiovascular diseases, sepsis, adult respiratory distress syndrome and acute renal failure. Cancer did not appear as a risk factor. The mortality during the ensuing hospital stay, however, was significantly influenced by cancer as well as the aforementioned risk factors. When controlled for severity of illness, expressed by the level of organ system failure after 48 h of ICU treatment, only sex, sepsis and severity of illness showed significant influence on the mortality in the ICU, and only sex and severity of illness significantly influenced mortality during the ensuing hospital stay after discharge from the ICU.     

Spectrum of acute renal failure and factors predicting its outcome in an intensive care unit in India

Identification of factors causing acute renal failure (ARF) and its associated poor prognosis in critically ill patients can help in planning strategies to prevent ARF and to prioritize the utilization of sparse and expensive therapeutic modalities. Most of the studies in such patients have been done in the developed world, and similar data from the developing world is sparse. We analyzed 45 consecutive patients who developed ARF in the intensive care unit (ICU) during a 12-month period. Demographic and detailed biochemical profile, previous chronic illness, precipitating factors, number of failed organs, type of ARF (oliguric/nonoliguric), and need for and type of renal replacement therapy (RRT) received were recorded at the time of admission to ICU and during the course of illness. The mean age of these patients was 43.1 years, with 75.6% being males. Hypotension, sepsis, and use of nephrotoxic drugs were common precipitating factors for ARF in these patients. However, multiple precipitating factors were present in the majority (80%): 81.5% had at least one organ failure prior to development of ARF, 71.1% had oliguria, and 71.1% required RRT. Intermittent hemodialysis was the most common form of RRT given. Patient mortality was 64.4%, with 15 of the 16 surviving patients becoming dialysis independent. We observed an increase in mortality from 0% to 100%, depending on the number of failed organs from one to six. On comparing the predictor outcomes between survivors and nonsurvivors by multivariate analysis, only the number of failed organs at the time of ARF (2.6 +/- 0.9 vs. 4.5 +/- 0.8) and serum albumin < 3.0 g/dL were found to be statistically significant. To conclude, ARF in critically ill patients is multifactorial in origin and carries a high mortality. Mortality in these patients increases with increasing numbers of failed organs and with a serum albumin of < 3.0 g/dL.     

Prognostic factors in acute renal failure due to sepsis. Results of a prospective multicentre study

BACKGROUND.: Sepsis is a major cause of acute renal failure in hospital patients,but its incidence and the associated prognostic factors haverarely been assessed prospectively by multivariate analysis. METHODS.: We conducted a prospective 6-month study in 20 multidisciplinaryintensive care units to assess the prognosis of patients hospitalizedwith acute renal failure due to sepsis. Sepsis syndrome andseptic shock were defined according to the criteria of the Societyof Critical Care Medicine Consensus Conference. Severity scoringindexes (SAPS, APACHE II, and organ system failure (OSF)) weremeasured on ICU admission and on inclusion. The end-point washospital mortality. RESULTS.: Acute renal failure had a septic origin in 157 patients (Group1), comprising 68 with septic shock and 89 with sepsis syndrome,and did not result from infection in 188 patients (Group 2).Patients with septic acute renal failure were older (mean age:62.2 versus 57.9 years, P<0.02) and had on inclusion a higherSAPS (19.3 versus 16.1, P<0.001), APACHE II (29.6 versus24.3, P<0.001), and OSF (2.07 versus 1.52, P<0.001) thanpatients with non-septic acute renal failure. They had a higherneed for mechanical ventilation (69.1% versus 47.3%, P<0.001),and acute renal failure was more often delayed during the ICUstay than was present on admission (47.7% versus 32.4% respectively,P<0.005). Hospital mortality was higher in patients withseptic acute renal failure (74.5%) than in those whose renalfailure did not result from sepsis (45.2%, P<0.001). Mortalitywas influenced by the presence of a septic shock (79.4%) orof a sepsis syndrome on inclusion (70.8%). Using a stepwiselogistic regression model, sepsis was an independent predictorof hospital mortality (OR, 2.51; 95% CI, 1.44–4.39) aswell as a delayed occurrence of acute renal failure, oliguria,an altered previous health status, hospitalization prior toICU, need for mechanical ventilation, age and severity scoringindexes on inclusion. In total patients, mortality was higherin dialyzed than in non-dialyzed patients (P<0.001), andin those treated by continuous compared to intermittent techniques(P<0.01). Patients dialysed with biocompatible membraneshad a lower mortality than those treated with cellulose membranes(P<0.005). CONCLUSIONS.: Patients with acute renal failure due to sepsis have a worseprognosis than those with non-septic acute renal failure. Sepsisand the above-defined predictive factors are to be consideredin studies on prognosis of ARF patients. Our results suggestthat the use of biocompatible membranes may reduce significantlymortality in these patients.     

Acute renal failure in the medical intensive care unit: predisposing, complicating factors and outcome.

The factors predisposing to and complicating acute renal failure (ARF) in the medical intensive care unit (ICU), and their relative influence on outcome during ARF are unclear. We retrospectively evaluated the relative importance of age, prior chronic disease (including chronic renal failure), sepsis and organ system failure, for development and outcome of ARF in the medical ICU. Of 487 consecutively admitted patients, 78 (16%) had ARF, in 63% treated with renal replacement therapy. Mortality was 63%. Independently from each other, advancing age, prior chronic disease, and cardiovascular and pulmonary failure directly related to the development of ARF, while neurological failure related inversely. Sepsis only contributed to ARF prediction from these variables if cardiopulmonary failure was excluded. Advancing age, cardiovascular failure before and after onset of ARF, pulmonary failure before ARF and use of renal replacement therapy were the major independent factors directly related to ARF mortality, while prior chronic renal failure related inversely and sepsis did not contribute. Hence, the outcome of ARF in a medical ICU is largely dependent on factors predisposing to ARF, even though the severity and complications of ARF may partly contribute. Our results may help in deciding on the prevention and therapy of ARF in a medical ICU.     

Influence of underlying disease on the outcome of critically ill patients with acute renal failure

BACKGROUND AND OBJECTIVE: The development of acute renal failure (ARF) in critically ill patients is associated with an increase in hospital mortality. Recently, it was shown that starting renal replacement therapy early and using high-filtrate flow rates can improve the outcome, but this could not be confirmed in later investigations. Studying selected patient subgroups could provide a useful basis for patient selection in future trials evaluating the outcome of renal replacement therapies. We, therefore, investigated the impact of the underlying disease on the outcome of patients with ARF. METHODS: We retrospectively analysed 306 patients with ARF who were treated with renal replacement therapy. Patients were classified according to six initial diagnosis groups: haemorrhagic shock, post-cardiac surgery, post-liver transplantation, trauma, severe sepsis and miscellaneous. Univariate and multivariate multiple logistic regression analysis was used to determine which factors influenced the outcome. RESULTS: Underlying disease proved to be the only independent risk factor for mortality that was present at intensive care unit (ICU) admission (P = 0.047). Patients with severe sepsis had a significantly higher mortality rate (68%) than ARF patients as a whole (51%) (P = 0.02). Length of stay in the ICU, the use of catecholamines, the delay before ARF onset, and the correlation between APACHE II score and ICU length of stay proved to be additional independent predictors of outcome. CONCLUSIONS: Patient selection and subgroup definition according to the underlying disease could augment the usefulness of future trials evaluating the outcome of ARF.     

Spectrum of Acute Renal Failure and Factors Predicting Its Outcome in an Intensive Care Unit in India

Identification of factors causing acute renal failure (ARF) and its associated poor prognosis in critically ill patients can help in planning strategies to prevent ARF and to prioritize the utilization of sparse and expensive therapeutic modalities. Most of the studies in such patients have been done in the developed world, and similar data from the developing world is sparse.

We analyzed 45 consecutive patients who developed ARF in the intensive care unit (ICU) during a 12-month period. Demographic and detailed biochemical profile, previous chronic illness, precipitating factors, number of failed organs, type of ARF (oliguric/nonoliguric), and need for and type of renal replacement therapy (RRT) received were recorded at the time of admission to ICU and during the course of illness. The mean age of these patients was 43.1 years, with 75.6% being males. Hypotension, sepsis, and use of nephrotoxic drugs were common precipitating factors for ARF in these patients. However, multiple precipitating factors were present in the majority (80%): 81.5% had at least one organ failure prior to development of ARF, 71.1% had oliguria, and 71.1% required RRT. Intermittent hemodialysis was the most common form of RRT given. Patient mortality was 64.4%, with 15 of the 16 surviving patients becoming dialysis independent. We observed an increase in mortality from 0% to 100%, depending on the number of failed organs from one to six. On comparing the predictor outcomes between survivors and nonsurvivors by multivariate analysis, only the number of failed organs at the time of ARF (2.6 ± 0.9 vs. 4.5 ± 0.8) and serum albumin <3.0 g/dL were found to be statistically significant.

To conclude, ARF in critically ill patients is multifactorial in origin and carries a high mortality. Mortality in these patients increases with increasing numbers of failed organs and with a serum albumin of <3.0 g/dL.     

Prediction of outcome in acute renal failure

In an attempt to predict outcome in acute renal failure (ARF) we have utilized multiple logistic regression to analyze clinical data from 151 patients with ARF seen over a 15-month period. Recovery of renal function occurred in 60% of patients with a 58% survival. Our analysis demonstrated sepsis, respiratory failure, and oliguria to be the major predictors of nonrecovery of renal function. A logistic equation was generated for prediction of outcome and was validated in a second independent group of patients with ARF. Prediction of outcome could be achieved with a sensitivity of 75% and a specificity of 80%. Maximum sensitivity (100%) was associated with a 17% specificity, while maximum specificity (98%) yielded a sensitivity of 20%.