Factors Related to Multiple Organ System Failure in Patients with Acute Renal Failure

Abstract

Multiple organ system failure (MOSF) is a frequent occurrence and the most important cause of death in the intensive care unit. In the pathogenesis of MOSF syndrome many factors participate: systemic inflammation caused by activation of immunoinflammatory cells with excessive release of mediators, hypovolemia, vascular endothelial damage, and ischaemic- induced gut mucosal injury with subsequent disruption of intestinal barrier function. The aim of this study is to analyze variables in relation with MOSF, and to determine correlation between multiple organ system failure and outcome of the acute renal failure (ARF). The clinical material of patients affected by ARF hospitalized in the Department of Nephrology, in the five- year period was used in this study. The study is retrospective, clinic-epidemiological, with 115 analyzed patients. Data analysis showed that 30.4% of patients had MOSF (MOSF score3 5). Multiple linear regression analysis selected: bacteremia, wound infection, coma on admission, number of blood transfusions as independent factors related to the high MOSF score. A strong positive correlation is established between MOSF and mortality (r = 0.93; p < 0.001). MOSF mortality is 65% and is the major cause of death in patients with ARF. Infections were maintained in 49.5% of patients, most frequent of them are urinary tract infection. Sepsis was present in 17.4% of patients with ARF. Patients with MOSF > 7 have significantly higher requirement of antibiotics and blood transfusions (p<0.005). Our results may be useful in strategies to prevent or limit the evolution of MOSF and to improve survival in patients with ARF.