4 (n = 39 (10%)) or crystalloids (n = 63 (17%)), or both HES 130/0.4 and crystalloids (n = 276 (73%)) (Figure (Figure2).2). The mean total amount of fluid given during the first 24 hours was 3,780 �� 2,487 ml (Table (Table3).3). During the first method 24 hours, red blood cell transfusion was required in 90 (24%) patients and vasopressors and inotropes were given to 307 (79%) and 71 (18%) patients, respectively. The 28-day mortality rate was 32%.Table 2Patient characteristics (data are shown as the median value with interquartile or in absolute value with percentage)Figure 2Number of patients receiving each type of fluid regimen during the initial 24-hour management period. HES, hydroxyethyl starch.Table 3Volume of fluid administered during the periods 0 to 6 hours and 6 to 24 hours and the total of fluid infused in the first 24 hours.

Patients with RRT and renal dysfunctionRRT was required in 90 (23%) out of 388 patients. In the patients who did not undergo RRT, an increase in plasma creatinine of at least 50% was found in 27 (7%) patients. An increase in plasma creatinine of less than 50% was identified in 237 (61%) patients. Of note, the course of the plasma creatinine during the first 24 hours could not be determined in 34 (8.8%) patients (missing data). A renal dysfunction was then confirmed in 117 of 364 patients (32%).Factors associated with renal dysfunctionAfter univariate and multivariate analyses, male gender, an increase in SAPS II scores, surgical patients, no decrease in SOFA scores during the first 24 hours and the interventional period of the study were independently associated with renal dysfunction (Table (Table4).

4). The mortality rate was higher in patients with renal dysfunction than in those without renal dysfunction (48% versus 24%, P < 0.01).Table 4Univariate and multivariate analyses for renal dysfunction and renal replacement therapyFactors associated with RRTAfter multivariate analysis, the need for vasopressors and the baseline value of plasma creatinine were independently associated with the need for RRT (Table (Table4).4). The mortality rates were 52% in patients requiring RRT and 26% in those not requiring RRT (P < 0.01).DiscussionThe present study focuses on the factors associated with the occurrence of renal dysfunction in patients with severe sepsis and septic shock. In our cohort, 73% of patients were given a combination of HES and crystalloids.

With respect to renal dysfunction [27], male gender, a high SAPS II score, no decrease in SOFA scores, the case-mix (surgery), and the interventional period of the Sepsi d’Oc study were identified as risk factors for renal dysfunction. The factors associated with the need for RRT were the baseline value of plasma Anacetrapib creatinine and the need for vasopressors. The administration of HES 130/0.4 in the first 24 hours of resuscitation was not associated with a risk of renal dysfunction.