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Volume 17 Supplement 4

Sepsis 2013

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Predictors of mortality in renal transplant recipients with severe sepsis and septic shock

  • 1,
  • 1,
  • 2,
  • 2 and
  • 1
Critical Care201317 (Suppl 4) :P36

https://doi.org/10.1186/cc12936

  • Published:

Keywords

  • Septic Shock
  • Renal Transplant
  • Severe Sepsis
  • Leukopenia
  • Renal Transplant Recipient

Background

Renal transplantation is the treatment of choice for end-stage renal disease as it is cost-effective, and improves survival and quality of life as compared with maintenance dialysis [1, 2]. However, the need for immunosuppression increases the hazard of septic complications [3]. Sepsis is one of the leading causes of death among renal transplant recipients and little is known about its characteristics in this population [4, 5]. The aim of this study was to evaluate the factors associated with mortality in renal transplant patients admitted to the ICU with severe sepsis and septic shock.

Materials and methods

We conducted a single-institution retrospective observational cohort study in consecutive renal transplant patients admitted to the ICU with severe sepsis or septic shock in a public high-volume kidney transplant center from 1 June 2010 and 31 December 2011. We registered demographic data, transplant characteristics and sepsis management to identify predictive factors of ICU, hospital and 1-year mortality.

Results

A total of 190 patients were enrolled. The mean age was 51 ± 13 years, 115 (60.5%) were male, 122 (64.2%) were deceased donors, median APACHE was 20 (16 to 23) and median admission SOFA was 5 (4 to 8). The most common source of infection was respiratory (59.5%) followed by urinary tract (16.8%). Tachypnea, tachycardia, fever, hypothermia, leukocytosis and leukopenia were present in 74.7%, 67.9%, 24.2%, 6.3%, 26.3% and 16.3% of the patients. The most prevalent dysfunction was respiratory (68.4%) followed by cardiovascular (41.1%) and renal (40.5%). The median time between transplantation and the septic event was 2.1 (0.6 to 7.8) years. The duration of organ dysfunction before the diagnosis of sepsis was 2.5 (1.1 to 5.2) hours. The median length of ICU and hospital stay was 6 (3 to 13) and 20 (12 to 35) days, respectively. Hospital and 1-year mortalities were 38.4% and 42.6%, respectively. In the multivariate analysis, male gender, the variation in the SOFA score after the first 24 hours, the need for mechanical ventilation, the presence of hematologic dysfunction, being admitted from the wards and AKI stage 3 were predictors of hospital mortality.

Conclusions

In the present study, independent factors associated with mortality were related to features of sepsis severity and not to factors associated with transplantation. Another interesting finding was the low frequency of signs of systemic inflammatory response.

Authors’ Affiliations

(1)
Nephrology Department, Federal University of São Paulo, Brazil
(2)
Anesthesiology, Pain and Intensive Care Department, Federal University of São Paulo, Brazil

References

  1. Garcia GG, Paul Harden P, Chapman J, World Kidney Day Steering Committee: The global role of kidney transplantation. Nephrol Dial Transplant 2013, 28: e1-e5. 10.1093/ndt/gfs013View ArticlePubMedGoogle Scholar
  2. United States Renal Data System: USRDS 2010 Annual Data Report: Atlas of Chronic Kidney Disease and End-stage Renal Disease in the United States. Bethesda, MD: National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases; 2010.Google Scholar
  3. Trzeciak S, Sharer R, Piper D, Chan T, Kessler C, Dellinger RP, et al.: Infections and severe sepsis in solid-organ transplant patients admitted from a university-based ED. Am J Emerg Med 2004, 22: 530-533. 10.1016/j.ajem.2004.09.010View ArticlePubMedGoogle Scholar
  4. Reis MA, Costa RS, Ferraz AS: Causes of death in renal transplant recipients: a study of 102 autopsies from 1968 to 1991. J R Soc Med 1995, 88: 24-27.PubMed CentralPubMedGoogle Scholar
  5. Sousa SR, Galante NZ, Barbosa DA, Pestana JOM: Incidência e fatores de risco para complicações infecciosas no primeiro ano após o transplante renal. J Bras Nefrol 2010, 32: 77-84. 10.1590/S0101-28002010000100013View ArticleGoogle Scholar

Copyright

© de Carvalho et al.; licensee BioMed Central Ltd. 2013

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

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