Fluid management and risk factors for renal dysfunction in patients with severe sepsis and/or septic shock

Autor: Jérôme Larché, Gilles Motte, Jean-Michel Constantin, Marc Leone, Bernard Allaouchiche, Laurent Favier, Sandrine Alonso, Laurent Muller, Sonia Lazarovici, Nicolas Molinari, Jean-Yves Lefrant, Carey M. Suehs, Samir Jaber, Luc Jacques
Přispěvatelé: Div Anesthesie Reanimat Douleur Urgences, Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Laboratoire d'Anatomie [CHU Montpellier], Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Hop St Eloi, Serv Anesthesie Reanimat B, Mathématiques, Informatique et STatistique pour l'Environnement et l'Agronomie (MISTEA), Institut National de la Recherche Agronomique (INRA)-Institut national d’études supérieures agronomiques de Montpellier (Montpellier SupAgro), Laboratoire de Biostatistique, Epidémiologie clinique, Santé Publique Innovation et Méthodologie [CHU Nîmes] (BESPIM), Hôpital Universitaire Carémeau [Nîmes] (CHU Nîmes), Centre Hospitalier Universitaire de Nîmes (CHU Nîmes)-Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Service Réanimation, Centre Hospitalier de Béziers, Service Réanimation Polyvalente, Centre Hospitalier de Narbonne, Centre Hospitalier Saint Jean de Perpignan, Centre Hospitalier de Carcassonne, Hôpitaux du Bassin de Thau, Serv Biostat Epidemiol Clin Sante Publ Informat M, Service Anesthésie et Réanimation [Hôpital Nord - APHM], Aix Marseille Université (AMU)-Assistance Publique - Hôpitaux de Marseille (APHM)- Hôpital Nord [CHU - APHM], Service Réanimation Adultes, CHU Clermont-Ferrand, Hôpital Edouard Herriot, Service Anesthésie Réanimation, Hôpital Edouard Herriot [CHU - HCL], Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL), Centre Hospitalier Régional Universitaire de Nîmes (CHRU Nîmes), Faculté de Médecine, Université Montpellier 1 (UM1), Centre Hospitalier Universitaire de Montpellier (CHU Montpellier ), Institut national d’études supérieures agronomiques de Montpellier (Montpellier SupAgro)-Institut National de la Recherche Agronomique (INRA), Centre hospitalier Intercommunal du Bassin de Thau, Centre Hospitalier Universitaire de Clermont-Ferrand, Institut national d'enseignement supérieur pour l'agriculture, l'alimentation et l'environnement (Institut Agro)-Institut national d'enseignement supérieur pour l'agriculture, l'alimentation et l'environnement (Institut Agro)
Rok vydání: 2012
Předmět:
Zdroj: Critical Care
Critical Care, 2012, 16 (1), pp.R34. ⟨10.1186/cc11213⟩
Critical Care, BioMed Central, 2012, 16 (1), pp.R34. ⟨10.1186/cc11213⟩
Critical Care 1 (16), R34. (2012)
ISSN: 1364-8535
1466-609X
DOI: 10.1186/cc11213
Popis: Introduction: The causative role of new hydroxyethyl starch (HES 130/0.4) in renal dysfunction frequency (a > 50% increase in serum creatinine or need for renal replacement therapy (RRT)) remains debated. Using the database of a multicenter 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 in a multicenter study of patients with severe sepsis and septic shock in 15 Southern French ICUs, 388 patients surviving after 24 hour, without a 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. Ninety 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, being 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.
Databáze: OpenAIRE
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