NDT Advance Access published online on December 7, 2007
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfm610
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Acute renal failure in patients with severe sepsis and septic shock—a significant independent risk factor for mortality: results from the German Prevalence Study
1Department of Nephrology and Medical Intensive Care, Charité Universitätsmedizin Berlin, Humboldt University, Berlin, 2Institute of Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, 3Department of Anaesthesiology and Intensive Care Medicine, Friedrich-Schiller University of Jena, Jena and 4Department of Nephrology and Hypertension, University of Erlangen-Nuremberg, Erlangen, Germany
Correspondence and offprint requests to: Michael Oppert, MD, Department of Nephrology and Medical Intensive Care, Charité, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany. Email: oppert{at}charite.de
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Abstract |
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Background. Sound data about the prevalence of acute renal failure (ARF) among patients with severe sepsis and septic shock are lacking. Further, it is not known whether ARF is an independent risk factor for mortality in septic patients or merely an indicator of disease severity.
Methods. A prospective cross-sectional one-day prevalence study was carried out in a representative sample of German ICUs, divided into five strata (< 200 beds; 201–400 beds; 401–600 beds; > 600 beds; university hospitals). 3877 patients were screened of whom 415 had severe sepsis and septic shock.
Results. Fourteen patients (3.4%) had chronic dialysis-dependent RF and were excluded from analysis. Of the remaining 401 patients, 166 (41.4%) had ARF, as defined by a rise in creatinine above twice the upper limit of normal and/or a drop in urine output to < 0.5 ml/kg bodyweight. Median APACHE II score was 22 in patients with ARF and 16 in patients without ARF (p< 0.0001). Patients with severe sepsis/septic shock had an overall hospital mortality of 55.2%. Hospital mortality in patients with ARF was 67.3% and without ARF 42.8% (p< 0.0001). After adjustment for APACHE II score and age, ARF remained a significant independent risk factor for death [odds ratio (OR) 2.11, 95% confidence interval (CI) 1.27-3.52]. Mortality in septic patients was not associated with pre-existing, non-dialysis-dependent chronic kidney disease, whereas in dialysis-dependent patients with sepsis mortality increased to 86%.
Conclusion. In this representative survey in patients with severe sepsis/septic shock, prevalence of ARF is high with 41.4%. ARF represents a significant independent risk factor for mortality in these patients.
Keywords: acute renal failure; epidemiology; mortality; sepsis
Received for publication: 20. 4.07
Accepted in revised form: 13. 8.07