Korean Journal of Nephrology 2000;19(2):271-277.

원저 : 패혈증에 의한 급성 신부전의 예견인자로서의 APACHE III prognostic system과 Liano system의 유용성 (Predictive Factors of Acute Renal Failure in Sepsis - APACHE III Prognostic System and Liano System)

신호진(Ho Jin Shin),이수봉(Soo Bong Lee),곽임수(Ihm Soo Kwak),나하연(Ha Yeon Rha),송상헌(Sang Heun Song),정현철(Hyun Chul Jung),배우형(Woo Hyung Bae),안승재(Seung Jae Ahn)

Abstract

Uncontrolled infection quite often 1eads to systemic inflammatory response syndrome and multi-organ dysfunction syndrome. Despite advances in medical knowledge and technology, the mortality of patient with sepsis is still 35-60%, and even reach up to 50-90% in septic patients having acute renal failure. The purpose of this study was to examine the characteristics and predictive factors of progression to acute renal failure(ARF) in sepsis. We analyzed the bacteriologic and laboratory data of 54 admitted patients with SIRS(systemic inflam-matory response syndrome) at Pusan National University Hospital from July 1997 to July 1999(ARF 23 vs non-ARF 31). Multiple factor which may influence mortality and progression to AEK in sepsis, were evaluated and measured on admission day. The following of results, 1) Of the 54 patients, 23 were ARF group and 31 were non-ARF group. Mean age were,52 years and 51 years. The mortality of ARF group and non-ARF group were 78% and 23%, Urine output, albumin, cholesterol, mean arterial blood pressure and evidence of underlying disease were not statistically different in each group. 2) Although the sources of sepsis could not identified in 9%(ARF), 23%(non-ARF), the others had the primary site of infections ' gastrointestinal tract(35% vs 29%), lung(30% vs 19%), genitourinary tract(9% vs 13%), skin(17% vs 16%). 3) Although statistically not different, gram-posi-tive bacterial infection was more common in ARF group(mainly staphylococcus aureus). Culture negative results were 4 patients(ARF), 1 patient(non- ARF). 4) APACHE III score in ARF group was higher than non-ARF group(48.1±16.5 vs 30.2±15.6). Liafio score in ARF group was higher than non-ARF group(39.1±13.0 vs 28.9±8.3). 5) APACHE III score and Liailo score in non- survivors were higher than survivors(APACHE III score:48.6±15.3 vs 28.1±14.0, Liaho score:37.9±12.0 vs 29.4±9.2) 6) APACHE lII system was positively correlated with Liaho system(r=0.512, p=0.001). In conclusion, APACHE III system and Liaho system were significant predictors of progression to ARF and mortality in sepsis. In the future, prospec-tive and multicenter studies are required to improve the method of treatment and the prognosis in sepsis.