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Mortality predictors in renal transplant recipients with severe sepsis and septic shock.

de Carvalho MA, Freitas FG, Silva Junior HT, Bafi AT, Machado FR, Pestana JO - PLoS ONE (2014)

Bottom Line: Multiple logistic regression was conducted to identify the independent risk factors associated with hospital mortality.The overall hospital mortality rate was 38.4%.In the multivariate analysis, the independent determinants of hospital mortality were male gender (OR = 5.9; 95% CI, 1.7-19.6; p = 0.004), delta SOFA 24 h (OR = 1.7; 95% CI, 1.2-2.3; p = 0.001), mechanical ventilation (OR = 30; 95% CI, 8.8-102.2; p<0.0001), hematologic dysfunction (OR = 6.8; 95% CI, 2.0-22.6; p = 0.002), admission from the ward (OR = 3.4; 95% CI, 1.2-9.7; p = 0.02) and acute kidney injury stage 3 (OR = 5.7; 95% CI,1.9-16.6; p = 0.002).

View Article: PubMed Central - PubMed

Affiliation: Unidade de Transplante, Disciplina de Nefrologia, Universidade Federal de São Paulo, São Paulo, SP, Brazil.

ABSTRACT

Introduction: The growing number of renal transplant recipients in a sustained immunosuppressive state is a factor that can contribute to increased incidence of sepsis. However, relatively little is known about sepsis in this population. The aim of this single-center study was to evaluate the factors associated with hospital mortality in renal transplant patients admitted to the intensive care unit (ICU) with severe sepsis and septic shock.

Methods: Patient demographics and transplant-related and ICU stay data were retrospectively collected. Multiple logistic regression was conducted to identify the independent risk factors associated with hospital mortality.

Results: A total of 190 patients were enrolled, 64.2% of whom received kidneys from deceased donors. The mean patient age was 51 ± 13 years (males, 115 [60.5%]), and the median APACHE II was 20 (16-23). The majority of patients developed sepsis late after the renal transplantation (2.1 [0.6-2.3] years). The lung was the most common infection site (59.5%). Upon ICU admission, 16.4% of the patients had ≤ 1 systemic inflammatory response syndrome criteria. Among the patients, 61.5% presented with ≥ 2 organ failures at admission, and 27.9% experienced septic shock within the first 24 hours of ICU admission. The overall hospital mortality rate was 38.4%. In the multivariate analysis, the independent determinants of hospital mortality were male gender (OR = 5.9; 95% CI, 1.7-19.6; p = 0.004), delta SOFA 24 h (OR = 1.7; 95% CI, 1.2-2.3; p = 0.001), mechanical ventilation (OR = 30; 95% CI, 8.8-102.2; p<0.0001), hematologic dysfunction (OR = 6.8; 95% CI, 2.0-22.6; p = 0.002), admission from the ward (OR = 3.4; 95% CI, 1.2-9.7; p = 0.02) and acute kidney injury stage 3 (OR = 5.7; 95% CI,1.9-16.6; p = 0.002).

Conclusions: Hospital mortality in renal transplant patients with severe sepsis and septic shock was associated with male gender, admission from the wards, worse SOFA scores on the first day and the presence of hematologic dysfunction, mechanical ventilation or advanced graft dysfunction.

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Frequency of systemic inflammatory response signs on intensive care unit admission.
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pone-0111610-g002: Frequency of systemic inflammatory response signs on intensive care unit admission.

Mentions: Upon ICU admission, 16.4% of the patients had ≤1 SIRS criterion (Figure 2). The most common SIRS criteria were tachypnea (74.7%) and tachycardia (67.9%). Two or more organ failures were present at admission in 61.5% of patients. Respiratory and hematological dysfunctions occurred more frequently in the non-survivors. Fifty-three patients (27.9%) experienced septic shock within the first 24 hours of ICU admission; however, 96 (50.5%) patients experienced septic shock during their ICU stays. The time for severe sepsis diagnosis was longer in the non-survivors. The patients who developed sepsis in the ward had worse outcomes than those patients in the emergency room (Table 2). The compliance rate with each component of the 6-hour bundle is shown in Table 2. The compliance rate for fluid administration (20 ml/kg crystalloid for hypotension or lactate ≥36 mg/dl) was higher among the survivors.


Mortality predictors in renal transplant recipients with severe sepsis and septic shock.

de Carvalho MA, Freitas FG, Silva Junior HT, Bafi AT, Machado FR, Pestana JO - PLoS ONE (2014)

Frequency of systemic inflammatory response signs on intensive care unit admission.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4219732&req=5

pone-0111610-g002: Frequency of systemic inflammatory response signs on intensive care unit admission.
Mentions: Upon ICU admission, 16.4% of the patients had ≤1 SIRS criterion (Figure 2). The most common SIRS criteria were tachypnea (74.7%) and tachycardia (67.9%). Two or more organ failures were present at admission in 61.5% of patients. Respiratory and hematological dysfunctions occurred more frequently in the non-survivors. Fifty-three patients (27.9%) experienced septic shock within the first 24 hours of ICU admission; however, 96 (50.5%) patients experienced septic shock during their ICU stays. The time for severe sepsis diagnosis was longer in the non-survivors. The patients who developed sepsis in the ward had worse outcomes than those patients in the emergency room (Table 2). The compliance rate with each component of the 6-hour bundle is shown in Table 2. The compliance rate for fluid administration (20 ml/kg crystalloid for hypotension or lactate ≥36 mg/dl) was higher among the survivors.

Bottom Line: Multiple logistic regression was conducted to identify the independent risk factors associated with hospital mortality.The overall hospital mortality rate was 38.4%.In the multivariate analysis, the independent determinants of hospital mortality were male gender (OR = 5.9; 95% CI, 1.7-19.6; p = 0.004), delta SOFA 24 h (OR = 1.7; 95% CI, 1.2-2.3; p = 0.001), mechanical ventilation (OR = 30; 95% CI, 8.8-102.2; p<0.0001), hematologic dysfunction (OR = 6.8; 95% CI, 2.0-22.6; p = 0.002), admission from the ward (OR = 3.4; 95% CI, 1.2-9.7; p = 0.02) and acute kidney injury stage 3 (OR = 5.7; 95% CI,1.9-16.6; p = 0.002).

View Article: PubMed Central - PubMed

Affiliation: Unidade de Transplante, Disciplina de Nefrologia, Universidade Federal de São Paulo, São Paulo, SP, Brazil.

ABSTRACT

Introduction: The growing number of renal transplant recipients in a sustained immunosuppressive state is a factor that can contribute to increased incidence of sepsis. However, relatively little is known about sepsis in this population. The aim of this single-center study was to evaluate the factors associated with hospital mortality in renal transplant patients admitted to the intensive care unit (ICU) with severe sepsis and septic shock.

Methods: Patient demographics and transplant-related and ICU stay data were retrospectively collected. Multiple logistic regression was conducted to identify the independent risk factors associated with hospital mortality.

Results: A total of 190 patients were enrolled, 64.2% of whom received kidneys from deceased donors. The mean patient age was 51 ± 13 years (males, 115 [60.5%]), and the median APACHE II was 20 (16-23). The majority of patients developed sepsis late after the renal transplantation (2.1 [0.6-2.3] years). The lung was the most common infection site (59.5%). Upon ICU admission, 16.4% of the patients had ≤ 1 systemic inflammatory response syndrome criteria. Among the patients, 61.5% presented with ≥ 2 organ failures at admission, and 27.9% experienced septic shock within the first 24 hours of ICU admission. The overall hospital mortality rate was 38.4%. In the multivariate analysis, the independent determinants of hospital mortality were male gender (OR = 5.9; 95% CI, 1.7-19.6; p = 0.004), delta SOFA 24 h (OR = 1.7; 95% CI, 1.2-2.3; p = 0.001), mechanical ventilation (OR = 30; 95% CI, 8.8-102.2; p<0.0001), hematologic dysfunction (OR = 6.8; 95% CI, 2.0-22.6; p = 0.002), admission from the ward (OR = 3.4; 95% CI, 1.2-9.7; p = 0.02) and acute kidney injury stage 3 (OR = 5.7; 95% CI,1.9-16.6; p = 0.002).

Conclusions: Hospital mortality in renal transplant patients with severe sepsis and septic shock was associated with male gender, admission from the wards, worse SOFA scores on the first day and the presence of hematologic dysfunction, mechanical ventilation or advanced graft dysfunction.

Show MeSH
Related in: MedlinePlus