Open Access

Acute renal failure in patients with sepsis

  • José António Lopes1Email author,
  • Sofia Jorge1,
  • Cristina Resina1,
  • Carla Santos2,
  • Álvaro Pereira2,
  • José Neves2,
  • Francisco Antunes2 and
  • Mateus Martins Prata1
Critical Care200711:411

https://doi.org/10.1186/cc5735

Published: 19 April 2007

The evaluation of acute renal failure (ARF) by the newly developed classification for ARF (RIFLE, standing for 'risk, injury, failure, loss, end-stage kidney disease') [1] in patients with sepsis has not yet been performed. We evaluated, retrospectively, the incidence of ARF and its risk factors, therapy, and outcome among patients with sepsis admitted to the Infectious Diseases Intensive Care Unit of the Hospital de Santa Maria between January 2005 and December 2006. ARF was defined by means of the RIFLE classification [1]. Sepsis was classified in accordance with the American College of Chest Physicians and the Society of Critical Care Medicine consensus [2]. In all, 182 patients (aged 56.2 ± 18.56 years (mean ± SD), 120 male, 162 Caucasian) were analyzed. Baseline characteristics of the patients are summarized in Table 1. Sixty-eight patients (37.4%) had ARF. By multivariate analysis, age more than 60 years (odds ratio (OR) 0.39, 95% confidence interval (CI) 0.17 to 0.87, P = 0.002), male (OR 5.5, 95% CI 2.2 to 13.5, P < 0.0001), chronic kidney disease (OR 0.2, 95% CI 0.06 to 0.79, P = 0.021), Gram-negative-related infection (OR 0.38, 95% CI 0.16 to 0.89, P = 0.027), and a Simplified Acute Physiology Score, version II (SAPS II) > 50 (OR 0.14, 95% CI 0.06 to 0.31, P < 0.0001) were independently associated with ARF. Thirteen patients (3 with injury and 10 with renal failure) had received renal replacement therapy (12 receiving continuous venovenous hemodiafiltration, and 1 receiving intermittent hemodialysis). The mortality rate was 37.4%, and increased from 'normal' to 'failure'. Patients who did not die had renal function recovery. Multivariate analysis including age more than 60 years, gender, SAPS II > 50, comorbidity (namely cardiovascular disease), and ARF showed that SAPS II > 50 (OR 0.12, 95% CI 0.05 to 0.29, P < 0.0001) and ARF (OR 0.26, 95% CI 0.11 to 0.63, P = 0.003) were independent predictors of mortality.
Table 1

Baseline characteristics

Variable

No AKI

Risk

Injury

Failure

P

n

114

11

21

36

 

Age (years)a

54 ± 18.2

61.9 ± 20.9

61.6 ± 13.4

61.8 ± 16.3

NS

Sex (male)

65 (57)

10 (91)

18 (85.7)

27 (75)

0.009

Race (Caucasian)

102 (89.5)

10 (91)

20 (95.2)

30 (83.3)

NS

Severe sepsisb

77 (67.5)

6 (54.5)

12 (57.1)

13 (36.1)

0.012

Septic shockb

25 (21.9)

4 (36.4)

8 (38)

23 (64)

<0.0001

CVD

37 (32.4)

3 (27.3)

10 (47.6)

14 (38.9)

NS

CKD

5 (43.9)

1 (9)

4 (19)

8 (22.2)

0.009

SAPS II > 50

22 (19.3)

6 (54.5)

7 (33.3)

9 (26.5)

0.06

Mortality

11 (9.6)

3 (27.3)

6 (28.6)

20 (55)

<0.0001

Figures in parentheses are percentages. AKI, acute kidney injury; CKD, chronic kidney disease; CVD, cardiovascular disease, diabetes mellitus and hypertension; NS, not significant; SAPS II, Simplified Acute Physiology Score, version II. The SAPS II was calculated on the basis of the worst variables recorded during the first 24 hours of ICU admission. aMeans ± SD; bsepsis was classified in accordance with American College of Chest Physicians and the Society of Critical Care Medicine consensus [2].

Thus, ARF as determined by RIFLE is common among patients with sepsis, and increases mortality. Age, gender, chronic kidney disease, Gram-negative-related infection and severity of illness are independently associated with ARF in this setting.

Abbreviations

ARF: 

acute renal failure

CI: 

confidence interval

OR: 

odds ratio

RIFLE: 

risk, injury, failure, loss, end-stage kidney disease

SAPS II: 

Simplified Acute Physiology Score, version II.

Declarations

Authors’ Affiliations

(1)
Department of Nephrology and Renal Transplantation, Hospital de Santa Maria
(2)
Department of Infectious Diseases, Hospital de Santa Maria

References

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Copyright

© BioMed Central Ltd 2007

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