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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...
Autores principales: | , , , , , , , , , , |
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Formato: | Texto |
Lenguaje: | English |
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Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo
2008
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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. |
format | Text |
id | pubmed-2664247 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2008 |
publisher | Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo |
record_format | MEDLINE/PubMed |
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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