[Mortality and risk factors in patients with acute renal failure and multiple organ dysfunction]

Acute renal failure (ARF) associated to multiple organ dysfunction (MOD) deserves currently a poor survival. The aim of this study was to analyze the risk factors for mortality in ARF-MOD patients treated by means of continuous renal replacements strategies.

All the ARF-MOD patients treated by means of continuous renal replacement techniques (CRRT) in a single center in the period 1989-1995 have been evaluated. MOD was defined by the 1992 American Conference criteria. Both demographic and the scored clinical data were analysed by means of descriptive and comparative statistics and by multiple logistic regression for the mortality risk factors.

103 patients have been evaluated. The median age was 62 years (range 20-80), 73.8% were males and the mean APACHE II score was 22.7 (SD 5.5). In the 17.4% the ARF-MOD condition corresponded to multiple trauma, the other medical and surgical pathologies represented the 82.6% of cases. At least two organic systems were involved in all patients. Both urea and creatinine values significantly decreased in all the patients and the fluid removal was of 8.9 (2.6) l/24 h. The mortality rate was 78.6%. The risk for death, as evaluated by logistic regression, was higher in patients older than 60 years (OR: 3.45; Cl 95%: 1.1-10.78; p = 0.03), and lower in those with remaining diuresis (OR: 0.65; Cl 95%: 0.48-0.9; p = 0.008). Survival was better among ARF-MOD traumatic patients.

The mortality rates among ARF-MOD patients remains high. The CRRT were useful for removing uremic toxins and fluids. By logistic regression only advanced age and low urine output were the main risk factors for mortality.