Predictive capacity of prognostic scores for kidney injury, dialysis, and death in intensive care units

Abstract

Objective: To assess the capacity of Charlson, SAPS 3 and SOFA scores to predict acute kidney injury, need for dialysis, and death in intensive care unit patients. Method: Prospective cohort, with 432 individuals admitted to four intensive care units. Clinical characteristics at admission, severity profile, and intensity of care were analyzed using association and correlation tests. The scores sensitivity and specificity were assessed using the ROC curve. Results: The results show that patients with acute kidney injury were older (65[27] years vs. 60[25] years, p = 0.019) and mostly are from the emergency department (57.9% vs. 38.0 %, p < 0.001), when compared to those in the group without acute kidney injury. For dialysis prediction, the results of SAPS 3 and SOFA were AUC: 0.590; 95%CI: 0.507–0.674; p-value: 0.032 and AUC: 0.667; 95%CI: 0.591–0.743; p-value: 0.000, respectively. All scores performed well for death. Conclusion: The prognostic scores showed good capacity to predict acute kidney injury, dialysis, and death. Charlson Comorbidity Index showed good predictive capacity for acute kidney injury and death; however, it did not perform well for the need for dialysis.

Preditores de mortalidade e tempo médio de sobrevivência dos pacientes críticos

“…Variáveis como o efeito vasoconstrictor da noradrenalina, imobilidade no leito, elevado escore do NAS e diminuição na frequência de mudança de decúbito do paciente, podem incidir em piores desfechos, como aumento da incidência lesões por pressão e lesão renal aguda (LRA-KDIGO 2 e 3). (22)(23)(24)(25) Sabe-se que o uso excessivo da noradrenalina pode aumentar os níveis de creatinina sérica e resultar na necessidade de diálise. Por isso, a noradrenalina tem sido associada à LRA na presença de hipovolemia e choque.…”

Temporal validation of the MMCD score to predict kidney replacement therapy and in-hospital mortality in COVID-19 patients

“…Other scores commonly used in intensive care have been tested to predict KTR among in-hospital patients, with poor results. A Brazilian study showed poor discrimination ability of the Simplified Acute Physiology Score 3 (SAPS3) and the Sequential Organ Failure Assessment (SOFA) to predict acute kidney injury and KRT requirement, with an area under the receiver operator characteristic curve (AUROC) of 0.590 (95% CI 0.507–0.674) and 0.667 (95% CI 0.591–0.743) [ 9 ].…”