The attributable mortality of acute renal failure in critically ill patients with liver cirrhosis

To determine outcome and mortality risk related to acute renal failure (ARF) in critically ill patients with cirrhosis. A retrospective cohort analysis and two independent case-control analyses in a medical ICU. 41 and 32 patients who developed mild and severe ARF, respectively, matched (1:2 ratio)...

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Bibliographic Details
Published in:Intensive care medicine 2005-12, Vol.31 (12), p.1693-1699
Main Authors: DU CHEYRON, Damien, BOUCHET, Bruno, PARIENTI, Jean-Jacques, RAMAKERS, Michel, CHARBONNEAU, Pierre
Format: Article
Language:English
Subjects:
Acute Kidney Injury - complications
Acute Kidney Injury - mortality
Acute renal failure
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
Biological and medical sciences
Care and treatment
Case studies
Case-Control Studies
Causes of
Chronic obstructive pulmonary disease
Clinical death. Palliative care. Organ gift and preservation
Critically ill
Emergency and intensive care: metabolism and nutrition disorders. Enteral and parenteral nutrition
Female
France - epidemiology
Health aspects
Hospital Mortality
Hospitals
Humans
Intensive care
Intensive care medicine
Intensive Care Units
Liver cirrhosis
Liver Cirrhosis - complications
Liver Cirrhosis - mortality
Liver diseases
Male
Matched-Pair Analysis
Medical prognosis
Medical sciences
Middle Aged
Mortality
Outcome and process assessment (Health Care)
Physiology
Proportional Hazards Models
Respiratory distress syndrome
Retrospective Studies
Risk Factors
Sepsis
Severity of Illness Index
Statistics, Nonparametric
Survival analysis
Treatment Outcome
United States
Ventilators
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Summary:To determine outcome and mortality risk related to acute renal failure (ARF) in critically ill patients with cirrhosis. A retrospective cohort analysis and two independent case-control analyses in a medical ICU. 41 and 32 patients who developed mild and severe ARF, respectively, matched (1:2 ratio) with cirrhotic patients without ARF during their ICU stay. Cirrhotic patients with ARF had higher MELD, APACHE II, and SOFA scores at baseline that those without ARF. They had more respiratory failure and cardiovascular failure during ICU stay, longer stay in ICU, and a greater crude hospital mortality rate (65% vs. 32%). Multivariate survival analysis identified ARF (hazard ratio, HR, 4.1), alcohol abuse or dependency, and severe sepsis or septic shock as independent predictors of death. In case-control studies both mild and severe ARF were independently associated with mortality (HR, 2.6, and 4.2, respectively). Cirrhotic patients with mild ARF patients had a higher risk of death than those without ARF (relative risk, RR, 2.0). Severe ARF was associated with an increase matched risk of death (RR 2.6), higher mortality of 51%, and higher risk-adjusted mortality rate (2.1 vs. 0.9). ICU patients with liver cirrhosis still have a high crude mortality. In this specific population ARF is associated with an excess mortality, depending on the severity of renal dysfunction.
ISSN:0342-4642
1432-1238
DOI:10.1007/s00134-005-2842-7