www.medenosrce.net/arhimed   arhimed(a-t>medenosrce.net   [21/04/2026 21:52:20] http://www.medenosrce.net/arhimed/poglej.asp?id=115 Prognosticni kazalci pri bolnikih z akutno ledvicno odpovedjo v intenzivni enoti zdravljenih s hemodializo Avtor: Gubenšek Jakob Mentor: prof. dr. Ponikvar Rafael IZHODIŠCE: Akutna ledvicna odpoved (ALO) se pri bolnikih v enoti intenzivne terapije (EIT) pojavlja pogosteje kot pri ostalih hospitaliziranih bolnikih. ALO v EIT se vecinoma pojavlja v sklopu vecorganske odpovedi in v vecini primerov zahteva zdravljenje z dializo (t.i. huda ALO). Smrtnost bolnikov s hudo ALO v EIT je kljub napredku dializnih metod še vedno visoka in se v razlicnih raziskavah giblje med 50 in 80%. Ob tako visoki smrtnosti, kot tudi sicer v klinicni medicini, je poznavanje bolnikove prognoze pomemben dejavnik. Za oceno prizadetosti bolnikov v EIT se pogosto uporabljata število prizadetih organskih sistemov in ocenjevalni sistem APACHE II, slednji omogoca tudi oceno možnosti preživetja. NAMEN: V naši raziskavi smo želeli preveriti vpliv dveh prognosticnih kazalcev: APACHE II in števila prizadetih organskih sistemov na smrtnost bolnikov z ALO v EIT, zdravljenih z dializo. HIPOTEZA: Naša hipoteza je bila: bolniki z ALO v EIT, ki imajo višje vrednosti APACHE II in vecje število prizadetih organskih sistemov na dan prve dialize, imajo slabše možnosti za preživetje. METODE: V prospektivno kohortno raziskavo smo vkljucili 37 zaporednih primerov hude ALO v razlicnih EIT Klinicnega centra v Ljubljani, pri katerih je bila dializa prvic opravljena v obdobju med 1. 12. 2001 in 15. 4. 2002. Bolnike smo spremljali dokler so potrebovali dializno zdravljenje ali umrli. Pri bolnikih smo ocenili ali je bila ledvicna funkcija že predhodno okvarjena. Na dan prve dialize in nato enkrat na teden v casu spremljanja smo izracunali vrednost APACHE II, ocenili število prizadetih organskih sistemov in zabeležili prisotnost hude sistemske okužbe, oligurije ali umetne ventilacije. REZULTATI: Bolniki so bili stari v povprecju 69 ± 11 let. Na dan prve dialize so imeli bolniki vrednost APACHE II v povprecju 25 ± 7, število prizadetih organskih sistemov (vkljucno z ledvicami) je bilo 3,2 ± 1,1, sindrom vecorganske prizadetosti je bil prisoten v 76%. Smrtnost je bila 68%. Skupini preživelih (N = 12) in umrlih (N = 25) sta bili primerljivi po starosti (68 ± 7,5 in 69 ± 13,0 let, p = NS) in razmerju med spoloma, pomembna je bila le razlika v casu dializnega zdravljenja (23 ± 12 in 14 ± 25 dni, p = 0,05). Preživeli in umrli se niso razlikovali v vrednosti APACHE II (25 ± 7 in 25 ± 7) in številu prizadetih organskih sistemov (3,3 ± 1,3 in 3,2 ± 1,0) ob prvi dializi, pravtako ne po najvišji vrednosti APACHE II (28 ± 7 in 28 ± 6) in najvecjem številu prizadetih organskih sistemov (3,9 ± 1,1 in 3,5 ± 1,0) v casu spremljanja. Primerjava smrtnosti podskupin glede na prisotnost predhodno slabše ledvicne funkcije, sindroma vecorganske odpovedi, sepse, oligurije ali umetne ventilacije ni pokazala statisticno pomembnega vpliva nobenega posameznega navedenega dejavnika na smrtnost. ZAKLJUCKI: Navedeni rezultati so ovrgli našo hipotezo. Sicer visoke vrednosti APACHE II in števila prizadetih organskih sistemov ob prvi dializi, ki pojasnjujejo visoko smrtnost bolnikov s hudo ALO v EIT, se niso pomembno razlikovale pri preživelih in umrlih bolnikih. Pravtako nismo dokazali vpliva vecorganske odpovedi, sepse, umetne ventilacije, oligurije in predhodno slabše ledvicne funkcije kot posameznih dejavnikov na smrtnost. «» [Abstract / English version] Prognosticni kazalci pri bolnikih z akutno ledvicno odpovedjo v intenzivni enoti zdravljenih s hemodializo Author: Gubenšek Jakob Mentor: prof. dr. Ponikvar Rafael BACKGROUND: In intensive care unit (ICU) patients acute renal failure (ARF) is more frequent than in other hospitalized patients. ARF in ICU patients is usually a part of multiple organ dysfunction syndrome (MODS) and in most cases requires dialytic support (i.e. severe ARF). Despite the progress in dialytic support, mortality rate of patients with severe ARF in ICU is still very high and ranges between 50 and 80% in different studies. Knowing prognosis is an important factor in such a high mortality rate patients. For assessing the severity of disease number of dysfunctioning organs and APACHE II score are commonly used, the later being also useful for evaluating patients' prognosis. AIM: The aim was to evaluate the impact of two prognostic indexes: APACHE II and number of failing organs on mortality rate of patients with ARF in ICU, treated with dialysis. HYPOTHESIS: Our hypothesis was: ARF patients in ICU with higher APACHE II values and more failing organs on the day of first dialysis treatment have worst survival rate. METHODS: In this prospective cohort study we included 37 consecutive cases of ARF in medical and surgical ICU's of University medical center in Ljubljana, in which first dialysis treatment was done between 1. 12. 2001 and 15.4. 2002. We followed the patients until they become dialysis independent or they died. We assessed if renal function was previously decreased. At first dialysis treatment and then once a week we calculated APACHE II score, assessed the number of failing organs, marked the presence of severe systemic infection, oliguria or mechanic ventilation. RESULTS: Mean age of patients was 69 ± 11 years. At first dialysis mean APACHE II value was 25 ± 7 and number of failing organs (including the kidneys) was 3,2 ± 1,1. MODS was present in 76% of patients. Mortality rate was 68%. Survivors and non-survivors were not significantly different in terms of age (68 ± 7,5 vs. 69 ± 13,0 years) and gender distribution, but only in duration of dialysis treatment (23 ± 12 vs. 14 ± 25 days, p = 0.05). Survivors and non-survivors did not differ neither in APACHE II values (25 ± 7 vs. 25 ± 7) and number of failing organs (3.3 ± 1.3, vs. 3.2 ± 1.0) at first dialysis, nor in maximal APACHE II values (28 ± 7 vs. 28 ± 6) and maximal number of failing organs (3.9 ± 1.1 vs. 3.5 ± 1.0) in time of dialisys treatments. Comparison of mortality rates of subgroups according to presence of previously decreased renal function, MODS, sepsis, oliguria or mechanical ventilation showed no significant specific influence of any single mentioned factor on mortality rate. CONCLUSIONS: Our results did not confirm our hypothesis. APACHE II values and number of failing organs at first dialysis were high, thus explaining the high mortality rate of our patients, but were not significantly different in survivors and non-survivors. Furthermore, we did not show any specific influence of MODS, sepsis, mechanical ventilation, oliguria or previously decreased renal function on mortality rate.