Prognostic factors in critically ill surgical patients requiring continuous renal replacement therapy

Acute mortality of unselected critically ill patients has improved during the last 15 years. Whether these benefits also affect long-term survival of critically ill surgical patients with severe acute renal failure is unclear, as are the prognostic factors relevant for survival time or mortality. We performed a retrospective analysis of data collected prospectively from March 1993, through February 2005. Data from a cohort of 170 consecutive postoperative patients without preceding kidney diseases but requiring continuous renal replacement therapy (CRRT) during intensive care unit (ICU) stay were analyzed. Six-month survival rate after ICU admission was 20.6%. In patients surviving more than 6 months, 5-year survival was 71.6%. After adjustment for relevant covariates, older age, disease severity at ICU admission, peritonitis and a large number of red cell units transfused during ICU stay were associated with worse 6-month prognosis. Duration of CRRT, and the origin and type of kidney failure were unimportant for prognosis, as was ICU admission date. Six-month prognosis of critically ill surgical patients with severe acute renal failure is poor and mostly determined by the disease severity at ICU admission and by the frequency of surgical complications. Outcome had not improved over the study period, but after successful surgical and intensive care therapy, long-term survival appears to be reasonably good.