DEATH RATE AND RISK-FACTORS FOR MORTALITY IN PATIENTS WITH ACUTE-RENAL-FAILURE AND MULTIORGANIC DYSFUNCTION

BACKGROUND: Acute renal failure (ARF) associated to multiorganic dysfu nction (MOD) deserves currently a poor survival. The aim of this study was to analyze the risk factors for mortality in ARF-MOD patients tre ated by means of continuous renal replacements strategies, PATIENTS AN D METHODS: All the ARF-MOD patients treated by means of continuous ren al replacement techniques (CRRT) in a single center in the period 1989 -1995 have been evaluated. MOD was defined by the 1992 American Confer ence criteria. Both demographic and the scored clinical data were anal ysed by means of descriptive and comparative statistics anb by multipl e logistic regression for the mortality risk factors. RESULTS: 103 pat ients have been evaluated. The median age was 62 years (range 20-80), 73.8% were males and the mean APACHE II score was 22.7 (SD 5.5). In th e 17.4% the ARF-MOD condition corresponded to polytraumatisms, the oth er medical and surgical pathologies represented the 82.6% of cases. At least two organic systems were involved in all patients, Both urea an d creatinine values significantly decreased in all the patients and th e fluid removal was of 8.9 (2.6) 1/24 h. The mortality rate was 78.6%. The risk for death, as evaluated by logistic regression, was higher i n patients older than 60 years (OR: 3.45; CI 95%: 1.1-10.78; p = 0.03) , and lower in those with reamining diuresis (OR: 0.65; CI 95%: 0.48-0 .9; p = 0.008). Survival was better among ARF-MOD traumatic patients. CONCLUSIONS: The mortality rates among ARF-MOD patients remains high. The CRRT were useful for removing uremic toxins and fluids. By logisti c regression only advanced age and low urine output were the main risk factors for mortality.