RENAL INVOLVEMENT IN THE SYSTEMIC INFLAMMATORY REACTION SYNDROME

Uncontrolled infection quite often leads to systemic inflammatory reac tion syndrome (SIRS) and multiorgan dysfunction (MOD) syndrome. Thirty -five consecutive patients (19 males) fulfilling strict diagnostic cri teria for SIRS were enrolled in two multicenter prospective double-bli nd trials involving new therapies for SIRS. The patients were followed prospectively up to day 28 after the enrollment. In the 35 patients w ith SIRS, males predominated in the age group below 40 (10/12, 83%) co mpared to the older group (nine males out of 23, 39%). Out of 16 femal es presenting with SIRS: only two were below the age of40. This distri bution was statistically different than our general MICU population. T he serum albumin in these patients was uniformly low, with a mean of 2 2.5 gm/L. The bulk of SIRS patients (22/35; 63%) went on to develop ac ute renal failure (ARF). Although statistically not different, skin an d peritoneal infections were more common in ARF group while pulmonary infections in non-ARF group. The majority of blood-cultures grew gram- positive organisms. Resolution of SIRS occurred within first 3 days in greater number of non-ARF survivors than ARF survivors (6/9, 66.7% vs . 6/16, 37.5%). Of the 22 ARF patients, 17 showed improvement in their renal function; the five who did nor, died before day 28. The overall mortality (about 32%) was similar in both groups. Patients who develo ped both ARF and ARDS did not survive. In conclusion. SIRS occurs most ly in elderly patients, almost always in patients with low albumin lev els. Premenopausal women seem to be protected. Blood cultures isolated a gram-positive organism in the majority of cases. Improvement in ser um creatinine suggests good prognosis. The mortality in ARF and non-AR F groups is similar.