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Mortality Predictors in Renal Transplant Recipients with Severe Sepsis and Septic Shock

INTRODUCTION: The growing number of renal transplant recipients in a sustained immunosuppressive state is a factor that can contribute to increased incidence of sepsis. However, relatively little is known about sepsis in this population. The aim of this single-center study was to evaluate the factor...

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Autores principales: de Carvalho, Mônica Andrade, Freitas, Flávio Geraldo Rezende, Silva Junior, Hélio Tedesco, Bafi, Antônio Toneti, Machado, Flávia Ribeiro, Pestana, José Osmar Medina
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4219732/
https://www.ncbi.nlm.nih.gov/pubmed/25369197
http://dx.doi.org/10.1371/journal.pone.0111610
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author de Carvalho, Mônica Andrade
Freitas, Flávio Geraldo Rezende
Silva Junior, Hélio Tedesco
Bafi, Antônio Toneti
Machado, Flávia Ribeiro
Pestana, José Osmar Medina
author_facet de Carvalho, Mônica Andrade
Freitas, Flávio Geraldo Rezende
Silva Junior, Hélio Tedesco
Bafi, Antônio Toneti
Machado, Flávia Ribeiro
Pestana, José Osmar Medina
author_sort de Carvalho, Mônica Andrade
collection PubMed
description INTRODUCTION: The growing number of renal transplant recipients in a sustained immunosuppressive state is a factor that can contribute to increased incidence of sepsis. However, relatively little is known about sepsis in this population. The aim of this single-center study was to evaluate the factors associated with hospital mortality in renal transplant patients admitted to the intensive care unit (ICU) with severe sepsis and septic shock. METHODS: Patient demographics and transplant-related and ICU stay data were retrospectively collected. Multiple logistic regression was conducted to identify the independent risk factors associated with hospital mortality. RESULTS: A total of 190 patients were enrolled, 64.2% of whom received kidneys from deceased donors. The mean patient age was 51±13 years (males, 115 [60.5%]), and the median APACHE II was 20 (16–23). The majority of patients developed sepsis late after the renal transplantation (2.1 [0.6–2.3] years). The lung was the most common infection site (59.5%). Upon ICU admission, 16.4% of the patients had ≤1 systemic inflammatory response syndrome criteria. Among the patients, 61.5% presented with ≥2 organ failures at admission, and 27.9% experienced septic shock within the first 24 hours of ICU admission. The overall hospital mortality rate was 38.4%. In the multivariate analysis, the independent determinants of hospital mortality were male gender (OR = 5.9; 95% CI, 1.7–19.6; p = 0.004), delta SOFA 24 h (OR = 1.7; 95% CI, 1.2–2.3; p = 0.001), mechanical ventilation (OR = 30; 95% CI, 8.8–102.2; p<0.0001), hematologic dysfunction (OR = 6.8; 95% CI, 2.0–22.6; p = 0.002), admission from the ward (OR = 3.4; 95% CI, 1.2–9.7; p = 0.02) and acute kidney injury stage 3 (OR = 5.7; 95% CI,1.9–16.6; p = 0.002). CONCLUSIONS: Hospital mortality in renal transplant patients with severe sepsis and septic shock was associated with male gender, admission from the wards, worse SOFA scores on the first day and the presence of hematologic dysfunction, mechanical ventilation or advanced graft dysfunction.
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spelling pubmed-42197322014-11-12 Mortality Predictors in Renal Transplant Recipients with Severe Sepsis and Septic Shock de Carvalho, Mônica Andrade Freitas, Flávio Geraldo Rezende Silva Junior, Hélio Tedesco Bafi, Antônio Toneti Machado, Flávia Ribeiro Pestana, José Osmar Medina PLoS One Research Article INTRODUCTION: The growing number of renal transplant recipients in a sustained immunosuppressive state is a factor that can contribute to increased incidence of sepsis. However, relatively little is known about sepsis in this population. The aim of this single-center study was to evaluate the factors associated with hospital mortality in renal transplant patients admitted to the intensive care unit (ICU) with severe sepsis and septic shock. METHODS: Patient demographics and transplant-related and ICU stay data were retrospectively collected. Multiple logistic regression was conducted to identify the independent risk factors associated with hospital mortality. RESULTS: A total of 190 patients were enrolled, 64.2% of whom received kidneys from deceased donors. The mean patient age was 51±13 years (males, 115 [60.5%]), and the median APACHE II was 20 (16–23). The majority of patients developed sepsis late after the renal transplantation (2.1 [0.6–2.3] years). The lung was the most common infection site (59.5%). Upon ICU admission, 16.4% of the patients had ≤1 systemic inflammatory response syndrome criteria. Among the patients, 61.5% presented with ≥2 organ failures at admission, and 27.9% experienced septic shock within the first 24 hours of ICU admission. The overall hospital mortality rate was 38.4%. In the multivariate analysis, the independent determinants of hospital mortality were male gender (OR = 5.9; 95% CI, 1.7–19.6; p = 0.004), delta SOFA 24 h (OR = 1.7; 95% CI, 1.2–2.3; p = 0.001), mechanical ventilation (OR = 30; 95% CI, 8.8–102.2; p<0.0001), hematologic dysfunction (OR = 6.8; 95% CI, 2.0–22.6; p = 0.002), admission from the ward (OR = 3.4; 95% CI, 1.2–9.7; p = 0.02) and acute kidney injury stage 3 (OR = 5.7; 95% CI,1.9–16.6; p = 0.002). CONCLUSIONS: Hospital mortality in renal transplant patients with severe sepsis and septic shock was associated with male gender, admission from the wards, worse SOFA scores on the first day and the presence of hematologic dysfunction, mechanical ventilation or advanced graft dysfunction. Public Library of Science 2014-11-04 /pmc/articles/PMC4219732/ /pubmed/25369197 http://dx.doi.org/10.1371/journal.pone.0111610 Text en © 2014 Carvalho et al http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited.
spellingShingle Research Article
de Carvalho, Mônica Andrade
Freitas, Flávio Geraldo Rezende
Silva Junior, Hélio Tedesco
Bafi, Antônio Toneti
Machado, Flávia Ribeiro
Pestana, José Osmar Medina
Mortality Predictors in Renal Transplant Recipients with Severe Sepsis and Septic Shock
title Mortality Predictors in Renal Transplant Recipients with Severe Sepsis and Septic Shock
title_full Mortality Predictors in Renal Transplant Recipients with Severe Sepsis and Septic Shock
title_fullStr Mortality Predictors in Renal Transplant Recipients with Severe Sepsis and Septic Shock
title_full_unstemmed Mortality Predictors in Renal Transplant Recipients with Severe Sepsis and Septic Shock
title_short Mortality Predictors in Renal Transplant Recipients with Severe Sepsis and Septic Shock
title_sort mortality predictors in renal transplant recipients with severe sepsis and septic shock
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4219732/
https://www.ncbi.nlm.nih.gov/pubmed/25369197
http://dx.doi.org/10.1371/journal.pone.0111610
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