PURPOSE:Acute renal failure (ARF) occurs in 23% and 51% of patients with severe sepsis and septic shock respectively with 70% mortality. ARF requiring dialysis by itself is an independent risk factor for mortality. We hypothesize that implementation of early goal directed therapy (EGDT) leads to improved outcomes of ARF in patients with severe sepsis and septic shock.
METHODS:This is an observational prospective study of all patients in severe sepsis and septic shock admitted to a single center, university affiliated closed medical intensive care unit (MICU) with 24/7 coverage by intensivists from January 2005 to June 2007. Standardized prospective data collection was implemented in March 2006. We compared the incidence and outcomes of ARF in patients with severe sepsis & septic shock post implementation. ARF was defined as admission serum creatinine values >1.1 mg/dL. All ESRD including renal transplant patients were excluded. Data was collected by an independent observer.
RESULTS:212 patients with severe sepsis and septic shock were admitted to the MICU during this period with median APACHE II score of 22. 170 patients had ARF (80%). Positive blood culture had a high correlation with ARF (90%) in patients having severe sepsis or septic shock. While there was no significant difference in the creatinine values at admission in both groups (pre-EGDT=3.07, post-EGDT=2.71 p=0.058), the creatinine on discharge was significantly different (pre-EGDT=2.24, post-EGDT=1.59 p=0.018). Improvement was seen in creatinine values in both groups, pre-EGDT (p<0.002) and post EGDT (p<0.00002). Mortality was reduced by 16% in the post EGDT group (p > 0.05) but the groups differed in APACHE scores. Hemodialysis requirement for ARF decreased by 50% in post-EGDT group but did not reach statistical difference.
CONCLUSION:Implementation of EGDT in severe sepsis and septic shock in addition to decreasing mortality and has a substantial impact on Renal morbidity. The limitations of our study include findings at a single center closed ICU.
CLINICAL IMPLICATIONS:Resuscitation strategies driven by standardized protocols for management of severe sepsis & septic shock improve renal outcomes.
DISCLOSURE:Hiren Pokharna, No Financial Disclosure Information; No Product/Research Disclosure Information