Acute renal failure in an intensive care unit in India - prognostic factors and outcome

We prospectively analyzed 70 consecutive patients who developed acute renal failure (ARF) in the intensive care unit (ICU) during a six year period to define prognostic factors and outcome. Age, sex, preexisting chronic disea ses, systemic infections, number of organs failing during the disease cours e, need and mode of renal replacement therapy (RRT), and lenght of stay in ICU were recorded. Analysis of factors in survivors (n=7, Gp A) and nonsurv ivors (n=63, Gp B) was done by univariate and multivariate analysis. The me an age of patients was 28.6 years. Forty nine (70%) patients developed ARF following surgery, whereas 21 (30%) developed ARF in a medical setting. Car diovascular surgery (39) and pancreatic surgery (7) were important causes i n the surgical group,whereas in the medical group acute pancreatitis (11) w as the main causative factor. One patient had ARF only, while in the rest, other organs were also involved. In more than 80% of these patients, organ failure and sepsis were present before the onset of ARF. Fifty two (74.3%) patients required dialytic support. The overall mortality was 90%. Number o f organs failing, (1.5 +/- 9 in Gp A vs 3.6 +/- 8 in Gp B), presence of sys temic infection (1 in Gp A vs 55 in Gp B), prolonged stay in ICU (3.7 +/- 1 .1 days in Gp A vs 8.0 +/- 5.4 in Gp B) and need for RRT (2 in Gp A vs 50 i n Gp B) correlated with the mortality. Using multiple logistic regression a nalysis, only multiple organ failure (3 or more) correlated with the mortal ity. We conclude that multiple organ failure is a poor prognostic factor in patients with ARF in the setting of the ICU.