These issues deserve future prospective evaluations.ConclusionsTogether with those of Elseviers et al. [22], our findings raise concern about the actual efficacy of RRT. Of course, these results must be cautiously interpreted since the selleck chemicals 17-AAG assessment of RRT efficacy through observational data is very challenging. However, they emphasize the need for a critical reappraisal of current RRT practices. Large randomized controlled trials comparing RRT to conservative management in selected ICU patients with AKI, and focusing on RRT timing, are urgently warranted to provide definite conclusions.Key messages? Aside from life-threatening conditions, evidence supporting the use of renal replacement therapy (RRT) in critically ill patients with acute kidney injury (AKI) is lacking.

Currently available data on RRT efficacy exclusively stem from observational studies, whose results may have been confounded by treatment selection bias and differences in patients’ severity.? In this study, we extensively dealt with confounding by using the propensity score technique and multivariate regression models to provide an as accurate as possible estimation of RRT efficacy.? RRT was not associated with decreased mortality and even seemed to impair patients’ outcome when initiated too late.? These results emphasize the need for further randomized studies comparing RRT to conservative management in selected ICU patients, with special focus on RRT timing.

AbbreviationsAKI: acute kidney injury; APACHE: Acute Physiology and Chronic Health Evaluation; CKD: chronic kidney disease; CI: confidence interval; GFR: glomerular filtration rate; ICU: intensive care unit; MDRD: Modification of Diet in Renal Disease; OR: odds ratio; RIFLE: Risk: Injury: Failure: Loss and End-stage renal failure; RRT: renal replacement therapy; SAPS: Simplified Acute Physiology Score; SOFA: Sequential Organ Failure Assessment.Competing interestsThe authors declare that they have no competing interests.Authors’ contributionsCC designed the study and wrote the manuscript; CC and JFT performed the statistical analyses; MD, AL, FC, EA, CS, ASD, MGO, DGT, and YC participated in the collection of data and critically revised the manuscript for important intellectual content. All authors read and approved the final manuscript.Supplementary MaterialAdditional file 1:Baseline characteristics of RIFLE R class patients with and without renal replacement therapy (RRT).Click here for file(40K, DOC)Additional file 2:Baseline characteristics of RIFLE I class patients with and without renal replacement therapy (RRT).Click here for file(40K, DOC)Additional file 3:Baseline characteristics of RIFLE F class patients with and without renal Entinostat replacement therapy (RRT).

These differences between reports are largely related to the definitions used to define infection [4,9,11], the different phases of sepsis [7,12], and organ dysfunction [10,13,14].In recent decades, several together epidemiological studies have been published focusing on sepsis and reporting data from ICUs in France (either partially or entirely) [4,8,11,15-17]. The only French study to date to have included exclusively patients with septic shock was published by Annane et al. [3] almost 10 years ago, with data collected between 1993 and 2000. The authors of all these studies have themselves acknowledged their limitations, which include: short inclusion periods [4,8,11,15,16] that preclude any evaluation of the impact of seasons; the heterogeneity of the patients included [4,8,11,16,18]; short follow-up (for example, 2 weeks) [16]; and use of a database using ICD definitions, with the inherent risk of wrong diagnostic codes, particularly since the codes were not standardized [3].

Despite these limiting factors, the data from French ICUs is sufficiently robust to allow comparison with data from other countries. The overall frequency of septic shock was 8.2 per 100 admissions (in 2000), and crude mortality in the ICU was 60.1%, declining from 62.1% in 1993 to 55.9% in 2000 [3].However, all these French observational studies were performed and reported before the publication of the Surviving Sepsis Campaign [7,19], and before the publication of French national guidelines for the management of sepsis published jointly by the two French scientific societies in critical care (Soci��t�� de R��animation de Langue Fran?aise (French-language society of intensive care, SRLF, and Soci��t�� Fran?aise d’Anesth��sie R��animation) in 2006 [20,21].

Reports from other countries suggest that compliance with these guidelines can have a positive impact on mortality [22,23].The objective of this study was to collect up-to-date epidemiological data from real-life practice in France on septic shock, to describe the survival probabilities at 3, 7, and 28 days after an initial episode of septic shock and to identify prognostic factors from these recent data.MethodsStudy populationThis prospective cohort included all consecutive adult patients with a diagnosis of septic shock admitted to 14 ICUs in 10 public hospitals (5 academic teaching hospitals and 5 non-academic general hospitals) in the North-East of France, between October 2009 and September 2011.

There were no specific non-inclusion criteria. Septic shock was defined based on the PROWESS-SHOCK study [24], namely documented or suspected infection requiring initiation of vasopressors despite adequate vascular filling, with at least one of the following hypoperfusion criteria: (1) metabolic acidosis (base excess ��5 mEq/L, AV-951 alkaline reserve <18 mEq/L or lactate ��2.