PROGNOSTIC FACTORS IN ACUTE-RENAL-FAILURE DUE TO SEPSIS - RESULTS OF A PROSPECTIVE MULTICENTER STUDY

Background. Sepsis is a major cause of acute renal failure in hospital patients, but its incidence and the associated prognostic factors hav e rarely been assessed prospectively by multivariate analysis. Methods . We conducted a prospective 6-month study in 20 multidisciplinary int ensive care units to assess the prognosis of patients hospitalized wit h acute renal failure due to sepsis. Sepsis syndrome and septic shock were defined according to the criteria of the Society of Critical Care Medicine Consensus Conference. Severity scoring indexes (SAPS, APACHE II, and failure (OSF)) were measured on ICU admission and on inclusio n. The end-point was hospital mortality. Results. Acute renal failure had a septic origin in 157 patients (Group 1), comprising 68 with sept ic shock and 89 with sepsis syndrome, and did not result from infectio n in 188 patients (Group 2). Patients with septic acute renal failure were older (mean age: 62.2 versus 57.9 years, P<0.02) and had on inclu sion a higher SAPS (19.3 versus 16.1, P<0.001), APACHE II (29.6 versus 24.3, P<0.001), and OSF (2.07 versus 1.52, P<0.001) than patients wit h non-septic acute renal failure. They had a higher need for mechanica l ventilation (69.1% versus 47.3%, P<0.001), and acute renal failure w as more often delayed during the ICU stay than was present on admissio n (47.7% versus 32.4% respectively, P<0.005). Hospital mortality was h igher in patients with septic acute renal failure (74.5%) than in thos e whose renal failure did not result from sepsis (45.2%, P<0.001). Mor tality was influenced by the presence of a septic shock (79.4%) or of a sepsis syndrome on inclusion (70.8%). Using a stepwise logistic regr ession model, sepsis was an independent predictor of hospital mortalit y (OR, 2.51; 95% CI, 1.44-4.39) as well as a delayed occurrence of acu te renal failure, oliguria, an altered previous health status, hospita lization prior to ICU, need for mechanical ventilation, age and severi ty scoring indexes on inclusion. In total patients, mortality was high er in dialyzed than in non-dialyzed patients (P<0.001), and in those t reated by continuous compared to intermittent techniques (P<0.01). Pat ients dialysed with biocompatible membranes had a lower mortality than those treated with cellulose membranes (P<0.005). Conclusions. Patien ts with acute renal failure due to sepsis have a worse prognosis than those with nonseptic acute renal failure. Sepsis and the above-defined predictive factors are to be considered in studies on prognosis of AR F patients. Our results suggest that the use of biocompatible membrane s may reduce significantly mortality in these patients.