Skip to content

Advertisement

  • Poster presentation
  • Open Access

Prognostic value of early vs late acute renal dysfunction in the critically ill obstetric patient

  • 1,
  • 2,
  • 2,
  • 2,
  • 2,
  • 2,
  • 2 and
  • 2
Critical Care200610 (Suppl 1) :P297

https://doi.org/10.1186/cc4644

  • Published:

Keywords

  • Hemolytic Uremic Syndrome
  • HELLP Syndrome
  • Uterine Atonia
  • Acute Renal Dysfunction
  • Referral Maternity

Introduction

Acute renal dysfunction/failure (ARF) is newly considered as an independent mortality risk factor in the ICU [1]. The time of onset of ARF could have a prognostic impact.

Objective

To determine prognosis of acquired vs not acquired renal dysfunction.

Methods

Retrospective analysis of prospectively collected data as part of the APRiMo study [2]. We defined ARF as serum creatinine level >100 μmol/l. We defined the early ARF group (E) as renal dysfunction that occurred during maternity management (less than 24 hours before transfer to the ICU) or at day 1 of ICU admission. The late ARF group (L) was defined as renal dysfunction occurring from day 2 of ICU admission. Inclusion criteria: critically ill obstetric patients presenting with one or more of the presenting conditions: severe pre-eclampsia/eclampsia, postpartum haemorrhage, stroke, HELLP syndrome, hemolytic uremic syndrome, and so on. Exclusion criteria: length of stay in the ICU <2 calendar days, chronic renal failure. Setting: patients first managed in a tertiary referral maternity for high-risk pregnancies, then transferred to our independent multidisciplinary ICU. Collected data: demographic, obstetric management, daily SOFA score. Main outcome of interest: vital status at ICU discharge. Adequate statistical tests were used (t test, chi-square test, etc.). P < 0.05 was considered significant.

Results

Six hundred and forty patients, overall mortality 13.3%, included n = 223: 193 in group E and 30 in group L. There was no difference in demographic data, main admission diagnosis between E and L groups. Mean maximum creatinine level: group E = 270 μmol/l, group L = 220 μmol/l (P = 0.15). Renal replacement therapy: 30/193 and 7/30 (P = 0.3). Comparing group L vs group E: L had a higher mortality rate (73% vs 20.7%; P < 0.001), duration of mechanical ventilation (5.8 ± 1 vs 3.5 ± 0,26; P = 0,001), rate of massive transfusion in the ICU (13/30 vs 34/193; P = 0.003) and length of stay (8.9 vs 6.2, P = 0.03). Mean day 1 MOD score summing organ dysfunctions without renal dysfunction: 7.6 ± 3.3 vs 5.5 ± 4 (P = 0.45). Mean total maximum MOD score (TM_MODS):11 ± 6 vs 6 ± 5, P = 0.001. For group E, nonsurvivors (NS) showed significantly more unstable haemo-dynamic state with a lower diastolic arterial pressure (P = 0.007), uterine atonia (P = 0.001), transfusion rate in the labor ward/ operating room and ICU stay than survivors (S). For group L, NS vs S: mean MODS at day 1 ICU admission 8.1 ± 3.7 vs 6.2 ± 2.7, P = 0.15), mean TM_MODS (16.2 ± 3.3 vs 7.8 ± 3.1, P < 0.001). NS were paradoxically younger than the S (29 years vs 35 years, P < 0.01). Duration of mechanical ventilation was higher among NS (P = 0.001). The main diagnosis of admission was postpartum hemorrhage complicating HELLP syndrome or sepsis. Three organ failures lasting >2 days (renal failure not counted) is associated with 100% mortality (n = 17).

Conclusion

Acquired ARF is an important prognostic factor. It is more serious than early ARF for the same level of serum creatinine.

Authors’ Affiliations

(1)
Groupe Hospitalier Pitié Salpêtrière, Paris, France
(2)
National Institute of Neurology, Tunis, Tunisia

References

  1. Druml C, et al.: Intensive Care Med. 2004, 30: 1886-1890. 10.1007/s00134-004-2344-zView ArticlePubMedGoogle Scholar
  2. Haddad , et al.: Crit Care. 2005, 9: S92-S93.Google Scholar

Copyright

© BioMed Central Ltd 2006

Advertisement