Value of TC-99m DMSA Renal Scan in Assessing the Prognosis and Outcome of Acute Renal Failure Due to Sepsis
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- Category: Vol. 81, March 2013
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Value of TC-99m DMSA Renal Scan in Assessing the Prognosis and Outcome of Acute Renal Failure Due to Sepsis,SUZY FAWZI, KARIM MASHHOUR, HATEM GAMAL EL DIN and AMR M. AMIN
Abstract
Background: Acute renal failure (ARF) is a common complication in patients admitted to the intensive care unit (ICU). Sepsis is also a well-known risk factor for the devel-opment of ARF. The combination of ARF and severe sepsis was reported to carry mortality up to 70%, whereas the mortality of ARF alone is 40-45%.
Aim of Work: The aim of the study is to evaluate the role of renal perfusion scanning in detecting the prognosis and outcome of patients with acute renal failure due to sepsis.
Methods: Forty patients with acute renal failure due to sepsis, aged between 15 and 74 years were enrolled in the study. They were monitored for their ICU prognosis and outcome after doing renal perfusion scanning. All patients were subjected to routine ICU and laboratory investigations including APACHE II and SOFA score.
Results: Thirty patients had normal renal scan and ten patients had abnormal renal scan. Mortality percentage was higher among abnormal renal scan (3/10:30%) compared to cases with normal renal scan (7/30:23.3%) with non-significant p-value 0.6. The median length of stay/day in ICU was longer among non-survivors than survivors 15.5±10, 11.5±8,p-value: 0.058 (approaching significance).
APACHE II score was higher in non-survivors than sur-vivors 23.9±3.2, 19.6±4.2, p-value: 0.0001. The percentage of mortality among cases that needed mechanical ventilation was higher (9/16 — 56.3%) compared to mortality cases that did not need mechanical ventilation (1/24-4.2% with p-value: 0.0001).
Conclusion: ARF may exert an independent adverse effect on outcome in septic and septic shock patients; it is also a risk factor for mortality. Tc-99m DMSA scanning is useful for detecting renal dysfunction and help to predict the outcome and prognosis.