Prognosis of Acute Renal Failure 1975-1995

Druml, Wilfred

doi:10.1159/000188991

Cited by 44 publications

(3 citation statements)

References 25 publications

(40 reference statements)

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“…The cut-off point that determines the increase in risk in most of the studies lies between 60 and 65 years with odds ratio values near ours (OR: 4.33) [25, 30, 31]. Sepsis, oliguric ARF and requirement for inotropics or mechanical ventilation have been noted as risk factors in previous studies [5, 25, 30, 32]; in our case, only requirement ventilation achieved a sufficient statistical power. As in other studies, the lack of prognostic value of the others could be attributed to some characteristics of the research design, such as the number of patients included and/or the short time evolution of SIRS [6, 8].…”

Section: Discussionsupporting

confidence: 59%

“…It is known that there is an increased mortality (>60%) when the ARF develops in a context of multiple organ dysfunction syndrome (MODS) [3, 4]. To predict the prognosis is very difficult if we take into account the various prognostic scorings, the series of risk factors and the mortality prediction models (MPM) described so far [5, 6, 7, 8]. On the other hand, no study of ARF has considered the prognostic value of specific factors related to endothelial damage and haemostatic imbalance, which have an important role in the systemic disturbances and in the evolution to MODS in patients with severe systemic inflammatory response syndrome (SIRS).…”

Section: Introductionmentioning

confidence: 99%

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Assessment of Haemostatic Risk Factors in Patients with Acute Renal Failure Associated with Severe Systemic Inflammatory Response Syndrome

García-Fernández¹,

Lavilla²,

Rocha

et al. 2002

Nephron

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Background/Aim: The prognosis of acute renal failure (ARF) in the Intensive Care Unit (ICU) is variable and depends mainly on the underlying disease. Consequently, the outcome prediction is difficult. The majority of the prognostic measures used include clinical parameters and routine laboratory tests but not no study has considered the prognostic value of haemostatic disturbances. These disturbances play a key role in the evolution of multiple organ dysfunction syndrome (MODS) in patients with ARF, which occurs as part of systemic inflammatory response syndrome (SIRS). The aim of the present study was to search for early significant predictive factors among a group of haemostatic parameters in these patients. Methods: Forty patients (age: 60.1 ± 14.1 years) with ARF (requiring renal replacement therapy) associated with SIRS and haemodynamic instability (systolic blood pressure <90 mm Hg and/or vasopressor drugs) were included. The plasmatic levels of the following haemostatic factors were measured within the first 6 h of the SIRS evolution: von Willebrand Factor (vWF), thrombomodulin, plasminogen activity inhibitor type 1 (PAI-1 antigen), tissue type plasminogen activator (t-PA antigen), prothrombin fragment 1 + 2 (F1 + 2), thrombin-antithrombin complexes (TAT) and D-dimer. Age, sex, medical or surgical disease, septic status or not, type of ARF (prerenal or acute tubular necrosis, oliguric or nonoliguric), and requirement for inotropics and mechanical ventilation were also considered. Univariate and multivariate logistic regressions were used to identify the risk factors for death and to develop a possible mortality prediction model on this basis. Results: By univariate analysis, high levels of PAI-1 antigen (≧60 ng/ml) and F1 + 2 (>2.5 nmol/l) at early phases of ARF-severe SIRS were found to be independent risk factors for death (odds ratio (OR) = 6.37, p = 0.0181 and OR = 5.49, p = 0.0238, respectively). Age over 61 years and requirement of mechanical ventilation were independent death risk factors (OR = 4.33, p = 0.0251 and OR = 2.4, p = 0.0078, respectively). A possible mortality prediction model was obtained including the age and the PAI-1 antigen and F1 + 2 variables. Conclusion: In patients with ARF associated with severe SIRS, the independent risk factors from the early phases of the process are not only the known variables such as advanced age, but also high levels of PAI-1 antigen and F1 + 2. In the future, the individual probability of death could be calculated by a prediction model which includes these variables.

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Section: Discussionsupporting

confidence: 59%

Section: Introductionmentioning

confidence: 99%

Assessment of Haemostatic Risk Factors in Patients with Acute Renal Failure Associated with Severe Systemic Inflammatory Response Syndrome

García-Fernández¹,

Lavilla²,

Rocha

et al. 2002

Nephron

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“…Acute kidney injury (AKI) is a frequent and often fatal complication of critical illness. 1,2 The causes of AKI in this setting are diverse but sepsis and septic shock are by far the most common etiologies. 3 Despite enormous advances in our ability to care for the critically ill that occurred over the last decades, especially in the area of renal replacement therapy (RRT), the mortality of septic patients with AKI remains unacceptably high, reaching up to 80% in some studies.…”

Section: Introductionmentioning

confidence: 99%

Inverse association between serum creatinine and mortality in acute kidney injury

Souza¹,

Matos²,

Barros³

et al. 2014

Jornal Brasileiro De Nefrologia

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In a cohort of septic AKI, oliguria and serum urea were the main indications for dialysis. We also described an inverse association between serum creatinine and mortality. Potential explanations for this finding include: delay in diagnosis, fluid overload with hemodilution of serum creatinine or poor nutritional status. This finding may also help to explain the low discriminative power of general severity scores - that assign higher risks to higher creatinine levels - in septic AKI patients.

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