Fluid management and risk factors for renal dysfunction in patients with severe sepsis and/or septic shock.
Crit Care. 2012 Feb 29;16(1):R34
Authors: Muller L, Jaber S, Molinari N, Favier L, Larche J, Motte G, Lazarovici S, Jacques L, Alonso S, Leone M, Constantin JM, Allaouchiche B, Suehs C, Lefrant JY, Group A
ABSTRACT: INTRODUCTION: The causative role of new HydroxyEthyl starch (HES 130/0.4) towards renal dysfunction frequency (a > 50% increase in serum creatinine or need of Renal Replacement Therapy (RRT)) remains debated. Using the database of a multicentre study focusing on patients with severe sepsis and septic shock, the present study aimed at identifying factors associated with the occurrence of renal dysfunction. METHODS: Among the 435 patients including in a multicenter study, patients with severe sepsis and septic shock in 15 Southern French ICUs, 388 surviving patients after 24 hour of evolution, without history of renal failure were included. Factors associated with renal dysfunction and RRT were isolated using a multivariate analysis with logistic regression. RESULTS: Renal dysfunction was reported in 117 (33%) patients. 90 patients required RRT. Among study participants, 379 (98%) were administered fluids in the first 24 hours of management: HES 130/0.4 only (n = 39), crystalloids only (n = 63), or both HES 130/0.4 and crystalloids (n = 276). RRT was independently associated with the need for vasopressors and the baseline value of serum creatinine in the first 24 hours. Multivariate analysis indicated that male gender, SAPS II score, a surgical patient, lack of decrease in SOFA score during the first 24 hours, and the interventional period of the study were independently associated with renal dysfunction. Mortality increased in the presence of renal dysfunction (48 versus 24%, p < 0.01). CONCLUSIONS: Despite being used in more than 80% of patients with severe sepsis and/or septic shock, the administration of HES 130/0.4 in the first 24 hours of management was not associated with the occurrence of renal dysfunction.
PMID: 22377234 [PubMed - as supplied by publisher]