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A positive fluid balance is associated with a worse outcome in patients with acute renal failure.

Payen D, de Pont AC, Sakr Y, Spies C, Reinhart K, Vincent JL, Sepsis Occurrence in Acutely Ill Patients (SOAP) Investigato - Crit Care (2008)

Bottom Line: The groups were compared with respect to patient characteristics, fluid balance, and outcome.In this large European multicenter study, a positive fluid balance was an important factor associated with increased 60-day mortality.Outcome among patients treated with RRT was better when RRT was started early in the course of the ICU stay.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Anesthesiology and Intensive Care, CHU Lariboisière, 2, rue Ambroise - Paré, F-75475 Paris Cedex 10, France.

ABSTRACT

Introduction: Despite significant improvements in intensive care medicine, the prognosis of acute renal failure (ARF) remains poor, with mortality ranging from 40% to 65%. The aim of the present observational study was to analyze the influence of patient characteristics and fluid balance on the outcome of ARF in intensive care unit (ICU) patients.

Methods: The data were extracted from the Sepsis Occurrence in Acutely Ill Patients (SOAP) study, a multicenter observational cohort study to which 198 ICUs from 24 European countries contributed. All adult patients admitted to a participating ICU between 1 and 15 May 2002, except those admitted for uncomplicated postoperative surveillance, were eligible for the study. For the purposes of this substudy, patients were divided into two groups according to whether they had ARF. The groups were compared with respect to patient characteristics, fluid balance, and outcome.

Results: Of the 3,147 patients included in the SOAP study, 1,120 (36%) had ARF at some point during their ICU stay. Sixty-day mortality rates were 36% in patients with ARF and 16% in patients without ARF (P < 0.01). Oliguric patients and patients treated with renal replacement therapy (RRT) had higher 60-day mortality rates than patients without oliguria or the need for RRT (41% versus 33% and 52% versus 32%, respectively; P < 0.01). Independent risk factors for 60-day mortality in the patients with ARF were age, Simplified Acute Physiology Score II (SAPS II), heart failure, liver cirrhosis, medical admission, mean fluid balance, and need for mechanical ventilation. Among patients treated with RRT, length of stay and mortality were lower when RRT was started early in the course of the ICU stay.

Conclusion: In this large European multicenter study, a positive fluid balance was an important factor associated with increased 60-day mortality. Outcome among patients treated with RRT was better when RRT was started early in the course of the ICU stay.

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Kaplan-Meier 60-day survival curves in patients without acute renal failure (ARF) and with early- and late-onset ARF.
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Figure 1: Kaplan-Meier 60-day survival curves in patients without acute renal failure (ARF) and with early- and late-onset ARF.

Mentions: Patients with ARF had higher mortality rates than patients without ARF (60-day mortality 35.7% versus 16.4%; P < 0.01) (Table 1). Mortality rates in patients with early and late ARF were similar (ICU mortality: 29.2% early, 33.2% late, P = 0.21; 60-day mortality: 35.2% early, 37.3% late, P = 0.54) (Figure 1). In the Cox regression analysis, seven variables were related to 60-day mortality in the patients with ARF: age, SAPS II, heart failure, liver cirrhosis, medical admission, mean fluid balance, and mechanical ventilation (Table 2). When patients with early- and late-onset ARF were analyzed separately, mean fluid balance was retained as an independent predictor of mortality only in the patients with early ARF. Mean fluid balance was significantly more positive in patients with early and late ARF than in patients without ARF throughout the first 7 days of the ICU stay (Figure 2). In all ARF groups, mean fluid balance was more positive among non-survivors than among survivors (Table 3). To analyze further the determinants of mortality and fluid balance in patients with ARF, we divided the patients into two groups according to urine output and treatment with RRT. In oliguric patients and in patients treated with RRT, mean fluid balance was significantly more positive than in non-oliguric and non-RRT patients, respectively, and mortality rates were significantly higher (Table 4). However, oliguric patients had shorter ICU and hospital stays than non-oliguric patients, whereas patients treated with RRT had longer ICU and hospital stays than non-RRT-treated patients. To analyze the influence of the time of initiation of RRT on outcome, we divided the RRT group into an early and a late RRT group, according to the time elapsed between ICU admission and the start of RRT. As shown in Table 5, patients in the early RRT group were more severely ill on ICU admission, as reflected by higher SAPS II and SOFA scores. Despite this greater severity of illness, length of stay was shorter and mortality was lower in the group in which RRT was started early in the course of the ICU stay (Table 5).


A positive fluid balance is associated with a worse outcome in patients with acute renal failure.

Payen D, de Pont AC, Sakr Y, Spies C, Reinhart K, Vincent JL, Sepsis Occurrence in Acutely Ill Patients (SOAP) Investigato - Crit Care (2008)

Kaplan-Meier 60-day survival curves in patients without acute renal failure (ARF) and with early- and late-onset ARF.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2481469&req=5

Figure 1: Kaplan-Meier 60-day survival curves in patients without acute renal failure (ARF) and with early- and late-onset ARF.
Mentions: Patients with ARF had higher mortality rates than patients without ARF (60-day mortality 35.7% versus 16.4%; P < 0.01) (Table 1). Mortality rates in patients with early and late ARF were similar (ICU mortality: 29.2% early, 33.2% late, P = 0.21; 60-day mortality: 35.2% early, 37.3% late, P = 0.54) (Figure 1). In the Cox regression analysis, seven variables were related to 60-day mortality in the patients with ARF: age, SAPS II, heart failure, liver cirrhosis, medical admission, mean fluid balance, and mechanical ventilation (Table 2). When patients with early- and late-onset ARF were analyzed separately, mean fluid balance was retained as an independent predictor of mortality only in the patients with early ARF. Mean fluid balance was significantly more positive in patients with early and late ARF than in patients without ARF throughout the first 7 days of the ICU stay (Figure 2). In all ARF groups, mean fluid balance was more positive among non-survivors than among survivors (Table 3). To analyze further the determinants of mortality and fluid balance in patients with ARF, we divided the patients into two groups according to urine output and treatment with RRT. In oliguric patients and in patients treated with RRT, mean fluid balance was significantly more positive than in non-oliguric and non-RRT patients, respectively, and mortality rates were significantly higher (Table 4). However, oliguric patients had shorter ICU and hospital stays than non-oliguric patients, whereas patients treated with RRT had longer ICU and hospital stays than non-RRT-treated patients. To analyze the influence of the time of initiation of RRT on outcome, we divided the RRT group into an early and a late RRT group, according to the time elapsed between ICU admission and the start of RRT. As shown in Table 5, patients in the early RRT group were more severely ill on ICU admission, as reflected by higher SAPS II and SOFA scores. Despite this greater severity of illness, length of stay was shorter and mortality was lower in the group in which RRT was started early in the course of the ICU stay (Table 5).

Bottom Line: The groups were compared with respect to patient characteristics, fluid balance, and outcome.In this large European multicenter study, a positive fluid balance was an important factor associated with increased 60-day mortality.Outcome among patients treated with RRT was better when RRT was started early in the course of the ICU stay.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Anesthesiology and Intensive Care, CHU Lariboisière, 2, rue Ambroise - Paré, F-75475 Paris Cedex 10, France.

ABSTRACT

Introduction: Despite significant improvements in intensive care medicine, the prognosis of acute renal failure (ARF) remains poor, with mortality ranging from 40% to 65%. The aim of the present observational study was to analyze the influence of patient characteristics and fluid balance on the outcome of ARF in intensive care unit (ICU) patients.

Methods: The data were extracted from the Sepsis Occurrence in Acutely Ill Patients (SOAP) study, a multicenter observational cohort study to which 198 ICUs from 24 European countries contributed. All adult patients admitted to a participating ICU between 1 and 15 May 2002, except those admitted for uncomplicated postoperative surveillance, were eligible for the study. For the purposes of this substudy, patients were divided into two groups according to whether they had ARF. The groups were compared with respect to patient characteristics, fluid balance, and outcome.

Results: Of the 3,147 patients included in the SOAP study, 1,120 (36%) had ARF at some point during their ICU stay. Sixty-day mortality rates were 36% in patients with ARF and 16% in patients without ARF (P < 0.01). Oliguric patients and patients treated with renal replacement therapy (RRT) had higher 60-day mortality rates than patients without oliguria or the need for RRT (41% versus 33% and 52% versus 32%, respectively; P < 0.01). Independent risk factors for 60-day mortality in the patients with ARF were age, Simplified Acute Physiology Score II (SAPS II), heart failure, liver cirrhosis, medical admission, mean fluid balance, and need for mechanical ventilation. Among patients treated with RRT, length of stay and mortality were lower when RRT was started early in the course of the ICU stay.

Conclusion: In this large European multicenter study, a positive fluid balance was an important factor associated with increased 60-day mortality. Outcome among patients treated with RRT was better when RRT was started early in the course of the ICU stay.

Show MeSH
Related in: MedlinePlus