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

L. Muller (1, 2) , S. Jaber (3) , Nicolas Molinari (4, 5, 2, 6) , L. Favier (7) , J. Larche (8) , G. Motte (9) , S. Lazarovici (10) , L. Jacques (11) , S. Alonso (12) , M. Leone (13) , J. M. Constantin (14) , B. Allaouchiche (15) , C. Suehs (12, 2) , J. Y. Lefrant (16, 2)

1 Div Anesthesie Reanimat Douleur Urgences
2 Laboratoire d'Anatomie [CHU Montpellier]
3 Hop St Eloi, Serv Anesthesie Reanimat B
4 MISTEA - Mathématiques, Informatique et STatistique pour l'Environnement et l'Agronomie
5 CHU Nîmes - Centre Hospitalier Universitaire de Nîmes
6 BESPIM - Laboratoire de Biostatistique, Epidémiologie clinique, Santé Publique Innovation et Méthodologie [CHU Nîmes]
7 Service Réanimation
8 Service Réanimation Polyvalente
9 Service Réanimation Polyvalente
10 Service Réanimation Polyvalente
11 Service Réanimation
12 Serv Biostat Epidemiol Clin Sante Publ Informat M
13 Service Anesthésie et Réanimation [Hôpital Nord - APHM]
14 Service Réanimation Adultes
15 Hôpital Edouard Herriot, Service Anesthésie Réanimation
16 Div Anesthesie Reanimat Douleur Urgences

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.

Domaines: Médecine humaine et pathologie

L. Muller, S. Jaber, Nicolas Molinari, L. Favier, J. Larche, et al.. Fluid management and risk factors for renal dysfunction in patients with severe sepsis and/or septic shock. Critical Care, 2012, 16 (1), pp.R34. ⟨10.1186/cc11213⟩. ⟨hal-01137076⟩