Daily evaluation of organ function during renal replacement therapy in intensive care unit patients with acute renal failure

Purpose: The aim of this study was to assess changes in organ function in acute renal failure patients during renal replacement therapy and relate them to outcome. Materials and Methods: Medical and nursing charts from 111 patients with acute renal failure who underwent renal replacement therapy (hemodialysis or hemofiltration) from July 2000 until July 2002 on a 31-bed medicosurgical intensive care unit (ICU) at a university hospital in Belgium and in whom the Sequential Organ Failure Assessment (SOFA) score was calculated daily before the start of therapy until the seventh day, or the end of therapy, were analyzed. Changes in SOFA score over time (,I SOFA) were calculated. Results: Of 111 patients, 63 (57%) died in the ICU. Nonsurvivors were older (68 [52-76] vs 59 [48-70] years, P =.017) and had initially higher respiratory, cardiovascular, and total SOFA scores compared with survivors. A greater Delta renal SOFA at 24 hours was associated univariantly with a higher risk of ICU mortality (odds ratio, 1.7; 95% confidence interval, 1.2-2.6; P =.013). In a multivariate analysis with ICU outcome as the dependent variable, only age, cardiovascular SOFA score on admission, and the change in total SOFA score over the first 24 hours were independently associated with a greater risk of death. Conclusions: Assessment of these factors in the first 24 hours of renal replacement therapy could help identify patients at higher risk of mortality early during their ICU admission. (C) 2006 Elsevier Inc. All rights reserved.