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Intensive Care Medicine

Published in:

01-10-2006 | Original

Renal failure in septic shock: predictive value of Doppler-based renal arterial resistive index

Authors: Nicolas Lerolle, Emmanuel Guérot, Christophe Faisy, Caroline Bornstain, Jean-Luc Diehl, Jean-Yves Fagon

Published in: Intensive Care Medicine | Issue 10/2006

Abstract

Objective

Because acute renal failure (ARF) is frequent in septic shock, an early marker of ARF could impact on management of such patients. High renal arterial resistive index (RI) is associated with parenchymatous renal failure. We assessed whether Doppler-measured RI on day 1 (D1) of septic shock can predict ARF.

Design

Prospective descriptive clinical study.

Setting

A 20-bed medical intensive care unit in a university hospital.

Patients

All patients with septic shock, excluding those with chronic renal failure (serum creatinine > 120 μmol/l).

Measurements and results

RI was determined during the first 24 h (D1) following vasopressor introduction, concomitant with recording of: age, SAPS II, mean arterial pressure, arterial lactate, catecholamine (dose and type), urine output and serum creatinine. ARF was diagnosed according to the RIFLE classification. RI measurement was possible for 35 of 37 included patients. On day 5 (D5), 17 patients were without ARF (RIFLE-0 or R) and 18 patients were classified as having ARF (RIFLE-I or F). On D1, RI was higher in these latter 18 patients (0.77 ± 0.08 vs. 0.68 ± 0.08, p < 0.001). They also had higher SAPS II and arterial lactate concentration. RI > 0.74 on D1 had a positive likelihood ratio of 3.3 (95% CI 1.1–35) for developing ARF on D5. RI correlated inversely with mean arterial pressure (ρ = –0.48, p = 0.006) but not with catecholamine type or dose or with lactate concentration.

Conclusion

Doppler-based determination of RI on D1 in septic shock patients may help identify those who will develop ARF.

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Title: Renal failure in septic shock: predictive value of Doppler-based renal arterial resistive index
Authors: Nicolas Lerolle
Emmanuel Guérot
Christophe Faisy
Caroline Bornstain
Jean-Luc Diehl
Jean-Yves Fagon
Publication date: 01-10-2006
Publisher: Springer-Verlag
Published in: Intensive Care Medicine / Issue 10/2006
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-006-0360-x

At a glance: The STEP trials

Springer Medicine

Renal failure in septic shock: predictive value of Doppler-based renal arterial resistive index

Abstract

Objective

Design

Setting

Patients

Measurements and results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Objective

Design

Setting

Patients

Measurements and results

Conclusion

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