Fatores de risco para óbito em pacientes críticos com insuficiência renal aguda
Palavras-chave:
Insuficiência renal aguda, Fatores de risco, Oligúria, Sepse, PrognósticoResumo
CONTEXTO E OBJETIVO: Insuficiência renal aguda é um problema comum e com alta taxa de mortalidade. O objetivo deste estudo é investigar os fatores de risco para óbito em pacientes críticos com insuficiência renal aguda. TIPO DE ESTUDO E LOCAL: Estudo retrospectivo com pacientes da unidade de terapia intensiva do Hospital Universitário Walter Cantídio, Fortaleza, Brasil. MÉTODOS: Foram comparados os sobreviventes com os não-sobreviventes, e realizada análise univariada e multivariada, para estabelecer os fatores de risco para óbito. RESULTADOS: Insuficiência renal aguda ocorreu em 128 pacientes (33,5%), sendo 79 homens (62%), com idade média de 49 ± 20 anos. Óbito ocorreu em 80 (62,5%). Os fatores mais freqüentemente associados ao óbito foram hipotensão, sepse, uso de drogas nefrotóxicas, insuficiência respiratória, insuficiência hepática, hipovolemia, choque séptico, disfunção de múltiplos órgãos, necessidade de drogas vasoati- vas, necessidade de ventilação mecânica, oligúria, hipoalbuminemia, acidose metabólica e anemia. Foi encontrada correlação negativa entre óbito e tempo de protrombina, hematócrito, hemoglobina, pressão arterial sistólica, pressão arterial diastólica, pH arterial, bicarbonato arterial e volume urinário. A análise multivariada mostrou como fatores de risco independentes para óbito: necessidade de ventilação mecânica (OR = 3,15; p = 0,03), hipotensão (OR = 3,48; p = 0,02), insuficiência hepática (OR = 5,37; p = 0,02), níveis baixos de bicarbonato arterial (OR = 0,85; p = 0,005), oligúria (OR = 3,36; p = 0,009), uso de drogas vasoativas (OR = 4,83; p = 0,004) e sepse (OR = 6,14; p = 0,003). CONCLUSÕES: Existem importantes fatores de risco para óbito em pacientes em cuidados intensivos, que devem ser prontamente identificados para tratamento precoce.
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