Features And Prognosis Of Critical Illness Patients With Acute Renal Failure

Objective:To assess the incidence, mortality,clinical spectrum,major causes, co-morbid chronic disease,outcoms and prognostic factors of acute renal failure in ICU patients.Data and Method:This retrospective study involved 2322 patients admitted to ICU during the period between Jan 2002 to Jun 2006 in Tianjin Medical University General Hospital. Patients who presented the criteria of ARF at admission or during the ICU stay were included in the study.. Data recorded included; patient Sex,Age, preexisting chronic dieases, underlying medical conditions responsible for ICU admission, common contributing factor to ARF, type of acute renal failure, Place and time of ARF occurrence(at home or in hospital),oilguria or non-oilguria laboratory data, number of organs failing during the disease course, APACHEⅡscore in 24 hours hospitalization, treatment details:(need for renal replacement, ventilation and vasoactive drugs therapy),length of stay in the ICU, Recovery of renal function and the final outcome of patnentsResults:155 cases developed ARF Among 2322 critically ill patients.The incidence of ARF was 6.68% in our ICU.82 Male, female 73 cases out of the 155 ARF patients. Mean age of patiens was 61.1±19.5years(from 14 to 91.years).The average stay in hospital was 16 days (from2 to 96 days). Coexisting chronic diseases was seen in 140 patients (90.3%) and 94 cases (61%) with 2 more kinds of chronic diseases.Heart disease (101patients), hypertension (48 paitents),diabetes mellitus (39 patients) and chronic kidney disease (normal renal.function,46 patients) were prominent comorbid.The common contributing factors to ARF were heart failure, septic shock, respiratory failure and hypovolemia.122 (78.7%)patients who developed ARF before hospitalization and 33 (21.3%) patients ARF developed during hospitalization.prerenal ARF 91 patients(58.8%), parenchymal ARF 62(40%) patients and postrenal ARF 2 (1.3%).patients.59(38.06%)patients were oliguria. Only 20(12.9%) patients were with Isolated ARF,while 87.1% patients were with other organs failure.2 or more organs failure were seen in 58(37.4%) patients. renal replacement therapy were reqired in.46 patients.11 of them were afford continuous hemofiltration and the remaing 35 patients were given intermittent haemodialysis.The major reasons for dialysis were persist oliguria, refractory heart failure with pulmonary edema and hyperkalemia.13(8.4%)patient requiring machanical ventilation, Diuretics were used in 48(31%) patients.41(26.4%)patients need for vasoactive agent support.After treatment,41.9%(65)patients achieved Full recovery of renal function,partial recovery in 28(18.1%)patients, norecovery. or deteriorated in 62 (40%)patients.The midium time of begining recover were 11 day (1 to 46 days). 65 died among ARF patients during hospitalzation,the hospital mortality was 41.9%.90 patient survived and 10 of them need constant dialysis. Multivariable logistic regression anlysis showed:older age, multiple organ failure, diabetes millitus,oliguria,cardiogenic shock,septic shock,need for vasoactive agent,norecovery of renal function and higher APACHEII score were Independent significant risk factors for martality of critically ill patients with ARF.Conclusion:The incidence of ARF in our ICU is 6.68% and the matorlity is 41.9%.ARF has often a multi-factorial etiology in critically ill patients who often coexisting, more kinds of chronic diseases and complicating 1 or more other organs failure. Usually those patients need comprehensive treatment.Older age, multiple organ failure, diabetes millitus,oliguria,cardiogenic shock,septic shock,need for vasoactive agent,norecovery of renal function and higher APACHEII score were poor prognostic parameters for ICU patients with ARF.The APACHE II score at hospital adimisson day is a valuable predictor of matorlity for patients wth ARF.