Infection as a risk factor in the outcome of patients with acute renal failure assessed by SOFA score

Acute renal failure (ARF) is a complex syndrome, frequently reported with mortality in 20-80% of the patients. Infection, as a cause or a complication of the syndrome, is a risk factor which unfavourably determines the outcome. A prospective 4-year study was performed of 112 ARF patients in the intensive care unit (ICU), with an evaluation of 68 clinical and laboratory parameters, as risk factors, at admission to the ICU. The scoring system used was SOFA (Sepsis-related Organ Failure Assessment). The outcome was associated with 27 risk factors among which infection as an acute ARF insult has shown a particularly strong correlation (p<0.0001). There was no association with infection as an intra-hospital complication. When divided according to the outcome (survivors vs. non-survivors), platelets, hematocrit, total protein and mean arterial pressure were significantly higher, while leucocytes and bilirubin significantly lower in the surviving group of patients. The parameters of the SOFA scoring system, such as the coagulation, liver and cardiovascular code, were statistically significant in relation to the outcome, and also the SOFA score taken as an independent variable (p<0.0001). The classification matrix of the analyzed SOFA scoring system was successful in the classification of 91.95% of the surviving and 48.00% of the non-surviving patients with ARF and the odds ratio was 41.0. Mortality rate in patients with ARF is 22.7%. Patients with ARF due to sepsis have a worse prognosis than those with non-septic ARF. Coagulation disorder, liver and cardiovascular dysfunction, as well as the SOFA score itself are independent variable in the outcome prediction. The SOFA score, derived from easily obtained data, is useful for judging survival prognosis in patients with ARF.