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Effects of Early Changes in Organ Dysfunctions on the Outcomes of Critically Ill Patients in Need of Renal Replacement Therapy

INTRODUCTION: Acute kidney injury usually develops in critically ill patients in the context of multiple organ dysfunctions. OBJECTIVE: To evaluate the effect of changes in associated organ dysfunctions over the first three days of renal replacement therapy on the outcomes of patients with acute kid...

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Autores principales: Maccariello, Elizabeth, Rocha, Eduardo, Valente, Carla, Nogueira, Lina, Rocha, Pedro T., Bonomo, Hélio, Serpa, Luciana F., Ismael, Márcia, Valença, Ricardo V. R., Machado, José E. S., Soares, Márcio
Formato: Texto
Lenguaje:English
Publicado: Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo 2008
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2664247/
https://www.ncbi.nlm.nih.gov/pubmed/18568244
http://dx.doi.org/10.1590/S1807-59322008000300010
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author Maccariello, Elizabeth
Rocha, Eduardo
Valente, Carla
Nogueira, Lina
Rocha, Pedro T.
Bonomo, Hélio
Serpa, Luciana F.
Ismael, Márcia
Valença, Ricardo V. R.
Machado, José E. S.
Soares, Márcio
author_facet Maccariello, Elizabeth
Rocha, Eduardo
Valente, Carla
Nogueira, Lina
Rocha, Pedro T.
Bonomo, Hélio
Serpa, Luciana F.
Ismael, Márcia
Valença, Ricardo V. R.
Machado, José E. S.
Soares, Márcio
author_sort Maccariello, Elizabeth
collection PubMed
description INTRODUCTION: Acute kidney injury usually develops in critically ill patients in the context of multiple organ dysfunctions. OBJECTIVE: To evaluate the effect of changes in associated organ dysfunctions over the first three days of renal replacement therapy on the outcomes of patients with acute kidney injury. METHODS: Over a 19-month period, we evaluated 260 patients admitted to the intensive care units of three tertiary-care hospitals who required renal replacement therapy for > 48 h. Organ dysfunctions were evaluated by SOFA score (excluding renal points) on the first (D1) and third (D3) days of renal replacement therapy. Absolute (A-SOFA) and relative (Δ-SOFA) changes in SOFA scores were also calculated. RESULTS: Hospital mortality rate was 75%. Organ dysfunctions worsened (A-SOFA>0) in 53%, remained unchanged (A-SOFA=0) in 17% and improved (A-SOFA<0) in 30% of patients; and mortality was lower in the last group (80% vs. 84% vs. 61%, p=0.003). SOFA on D1 (p<0.001), SOFA on D3 (p<0.001), A-SOFA (p=0.019) and Δ-SOFA (p=0.016) were higher in non-survivors. However, neither A-SOFA nor Δ-SOFA discriminated survivors from non-survivors on an individual basis. Adjusting for other covariates (including SOFA on D1), A-SOFA and Δ-SOFA were associated with increased mortality, and patients in whom SOFA scores worsened or remained unchanged had poorer outcomes. CONCLUSIONS: In addition to baseline values, early changes in SOFA score after the start of renal replacement therapy were associated with hospital mortality. However, no prognostic score should be used as the only parameter to predict individual outcomes.
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spelling pubmed-26642472009-05-13 Effects of Early Changes in Organ Dysfunctions on the Outcomes of Critically Ill Patients in Need of Renal Replacement Therapy Maccariello, Elizabeth Rocha, Eduardo Valente, Carla Nogueira, Lina Rocha, Pedro T. Bonomo, Hélio Serpa, Luciana F. Ismael, Márcia Valença, Ricardo V. R. Machado, José E. S. Soares, Márcio Clinics Clinical Science INTRODUCTION: Acute kidney injury usually develops in critically ill patients in the context of multiple organ dysfunctions. OBJECTIVE: To evaluate the effect of changes in associated organ dysfunctions over the first three days of renal replacement therapy on the outcomes of patients with acute kidney injury. METHODS: Over a 19-month period, we evaluated 260 patients admitted to the intensive care units of three tertiary-care hospitals who required renal replacement therapy for > 48 h. Organ dysfunctions were evaluated by SOFA score (excluding renal points) on the first (D1) and third (D3) days of renal replacement therapy. Absolute (A-SOFA) and relative (Δ-SOFA) changes in SOFA scores were also calculated. RESULTS: Hospital mortality rate was 75%. Organ dysfunctions worsened (A-SOFA>0) in 53%, remained unchanged (A-SOFA=0) in 17% and improved (A-SOFA<0) in 30% of patients; and mortality was lower in the last group (80% vs. 84% vs. 61%, p=0.003). SOFA on D1 (p<0.001), SOFA on D3 (p<0.001), A-SOFA (p=0.019) and Δ-SOFA (p=0.016) were higher in non-survivors. However, neither A-SOFA nor Δ-SOFA discriminated survivors from non-survivors on an individual basis. Adjusting for other covariates (including SOFA on D1), A-SOFA and Δ-SOFA were associated with increased mortality, and patients in whom SOFA scores worsened or remained unchanged had poorer outcomes. CONCLUSIONS: In addition to baseline values, early changes in SOFA score after the start of renal replacement therapy were associated with hospital mortality. However, no prognostic score should be used as the only parameter to predict individual outcomes. Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo 2008-06 /pmc/articles/PMC2664247/ /pubmed/18568244 http://dx.doi.org/10.1590/S1807-59322008000300010 Text en Copyright © 2008 Hospital das Clínicas da FMUSP
spellingShingle Clinical Science
Maccariello, Elizabeth
Rocha, Eduardo
Valente, Carla
Nogueira, Lina
Rocha, Pedro T.
Bonomo, Hélio
Serpa, Luciana F.
Ismael, Márcia
Valença, Ricardo V. R.
Machado, José E. S.
Soares, Márcio
Effects of Early Changes in Organ Dysfunctions on the Outcomes of Critically Ill Patients in Need of Renal Replacement Therapy
title Effects of Early Changes in Organ Dysfunctions on the Outcomes of Critically Ill Patients in Need of Renal Replacement Therapy
title_full Effects of Early Changes in Organ Dysfunctions on the Outcomes of Critically Ill Patients in Need of Renal Replacement Therapy
title_fullStr Effects of Early Changes in Organ Dysfunctions on the Outcomes of Critically Ill Patients in Need of Renal Replacement Therapy
title_full_unstemmed Effects of Early Changes in Organ Dysfunctions on the Outcomes of Critically Ill Patients in Need of Renal Replacement Therapy
title_short Effects of Early Changes in Organ Dysfunctions on the Outcomes of Critically Ill Patients in Need of Renal Replacement Therapy
title_sort effects of early changes in organ dysfunctions on the outcomes of critically ill patients in need of renal replacement therapy
topic Clinical Science
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2664247/
https://www.ncbi.nlm.nih.gov/pubmed/18568244
http://dx.doi.org/10.1590/S1807-59322008000300010
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