O ICU, data necessary for the calculation of SAPS II and APACHE II, duration of mechanical ventilation, length of stay in ICU, mortality and graft survival at both ICU and hospital discharge. Patient and graft survival were also collected 6 months after ICU discharge. Results: Thirty ICU admissions in 26 adult renal transplant recipients were studied. The median of prior post-transplant duration was 3 months (10 days?0 months), and of end-stage renal disease was 68 months (5?40). Reasons for admission were: sepsis (n = 11), hemorrhage (n = 4), cardiopathy/fluid overload (n = 4), coma (n = 4), abdominal crisis (n = 4), others (n = 3). The overall ICU mortality was 33 . There was no difference between the observed hospital mortality (40 ) and the expected mortality as predicted by SAPS II (36.6 ) or APACHE II (50 ). The area under the receiver operating characteristic curve was 0.85 ?0.08 for SAPS II and 0.84 ?0.08 for APACHE II. The variables associated with ICU mortality were: (i) ICU admission without hospital discharge after transplantation (RR = 2.5), (ii) mechanical ventilation requirement (RR > 20), (iii) vasoactive drugs use (RR = 5.6). Use of immunosuppressive drugs was not different between survivors and nonsurvivors. At ICU discharge, graft survival among survivors was 48 . At 6 months, 5 additional renal transplant recipients had died. Conclusion: The mortality of renal transplant recipients admitted in ICU is high and graft loss during ICU stay is frequent.P222 ICU acquired acute renal failure carries a higher mortality than acute renal failure on admission to ICUM Ostermann, S Nelson, R Chang, for the RIP Users Group Department of Nephrology, St George’s Hospital, London SW17 0QT, UK Acute renal failure (ARF) has a significant impact on outcome of critically ill patients [1]. The aim of this study was PubMed ID:http://www.ncbi.nlm.nih.gov/pubmed/20719582 to identify any differences between patients with ARF on admission to the intensive care unit (ICU) and patients developing ARF during their stay in the ICU. We retrospectively analysed data from The Riyadh Intensive Care Program (RIP) database which contains demographic data of 26,669 patients admitted to 21 ICUs in the United Kingdom (UK) during the time period June 1989 until September 1996. ARF was defined according to the organ system failure scoring system by Knaus et al [2]. Patients with chronic renal failure were excluded. get Rutaecarpine Comment: Our study confirms that ARF increases mortality in ICU patients with a further marked increase amongst patients who require renal replacement therapy (RRT). Patients who develop ARF during their stay in the ICU have a significantly worse outcome compared to patients with ARF on admission to ICU. Related costs were calculated using a modified `top down’ method. Results: 303 patients with a hospital mortality of 14.5 were included in the study. Overall 241 patients (79.5 ), including all non-survivors, received AT during their ICU stay. ICU and hospital mortality, ICU LOS, costs, admission diagnosis, and source of admission were different in AT vs NAT patients (P < 0.05). Conclusion: Since ICUs consume a large proportion of hospital budgets for a minority of patients admission should be limited to those depending on these facilities. Categorisation into AT and NAT using TISS 28 may well serve to identify these patients. Our data suggest superfluous ICU admission in 20 of all patients staying longer than 24 hours in the index ICU. Identification and careful analysis of this patients might hel.
