Predicting patient outcome from acute renal failure comparing three general severity of illness scoring systems

Fiaccadori, Enrico; Maggiore, Umberto; Lombardi, Maria; Leonardi, Sabina; Rotelli, Carlo; Borghetti, A

doi:10.1046/j.1523-1755.2000.00164.x

Cited by 62 publications

(47 citation statements)

References 41 publications

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“…[12] In a comparative study of the three different organ failure scoring systems, none could predict outcome in individual patients. [13] Herbert et al showed a strong association between the number of organ system failures and 30-day mortality in a prospective study of sepsis patients. [14] In another study on multiorgan dysfunction syndrome, the continuous variables of multiple organ dysfunction score were converted to discrete cutoff points to define the presence or absence of organ failure.…”

Section: Discussionmentioning

confidence: 99%

Predictors of Mortality in Acute Renal Failure in a Developing Country: A Prospective Study

et al. 2007

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Acute renal failure (ARF) occurs in wide range of conditions, making the evaluation of its prognosis a difficult task. Data regarding prognostic factors in ARF in a general population in developing countries are scarce. The objective of the study was to describe predictors of mortality in ARF that are relevant in the developing world. This prospective study was carried out over a one-year period; all hospitalized adults with ARF were included in the study. Predictors of mortality studied included causes of ARF, pre-existing diseases, and severity as well as complications of ARF. Of 33,301 patients admitted during the study period, 294 (0.88%) were either admitted with or developed ARF after hospitalization. Mean age was 43.9 ± 16.9 (18-86 yrs). Sepsis was the most common cause (63.26%). Pre-existing diseases like cardiovascular disease (CVSD), respiratory system disease (RSD), central nervous system disease (CNSD), hypertension, diabetet mellitus (DM), and malignancy were significantly higher in elderly as compared to younger patients. On univariate analysis sepsis, hypoperfusion as a cause of ARF and hospital-acquired ARF were associated with higher mortality. Pre-existing diseases viz. RSD, CVSD, CNSD, and DM had higher mortality. Among the severity and complications of ARF, oliguria, bleeding and infection during the course of ARF and critical illness were predictors of poor outcome. Age >60 yrs was associated with significantly higher mortality. However, on multivariate analysis, only critical illness (odds ratio 37.3), age > 60 years (odds ratio of 5.6), and sepsis as cause of ARF (odds ratio of 2.6) were found to be independent predictors of mortality.

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Section: Discussionmentioning

confidence: 99%

Predictors of Mortality in Acute Renal Failure in a Developing Country: A Prospective Study

et al. 2007

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“…Demographic and clinical data were taken from the clinical and administrative database of the ward, including the Acute Physiology and Chronic Health Evaluation (APACHE) score in version II (31) at RRT start (32), and the Model for End-Stage Liver Disease (MELD) score (33). MELD is a prospectively developed and validated liver disease severity scoring system that uses a patient's laboratory values for serum bilirubin, serum creatinine, and the international normalized ratio for prothrombin time.…”

Section: Data Collectionmentioning

confidence: 99%

Efficacy and Safety of a Citrate-Based Protocol for Sustained Low-Efficiency Dialysis in AKI Using Standard Dialysis Equipment

Fiaccadori¹,

Regolisti²,

Cademartiri³

et al. 2013

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives A simple anticoagulation protocol was developed for sustained low-efficiency dialysis (SLED) in patients with AKI, based on the use of anticoagulant citrate dextrose solution formulation A (ACD-A) and standard dialysis equipment. Patients' blood recalcification was obtained from calcium backtransport from dialysis fluid.Design, setting, participants, & measurements All patients treated with SLED (8-to 12-hour sessions) for AKI in four intensive care units of a university hospital were studied over a 30-month period, from May 1, 2008 to September 30, 2010. SLED interruptions and their causes, hemorrhagic complications, as well as coagulation parameters, ionized calcium, and blood citrate levels were recorded.Results This study examined 807 SLED sessions in 116 patients (mean age of 69.7 years [SD 12.1]; mean Acute Physiology and Chronic Health Evaluation II score of 23.8 [4.6]). Major bleeding was observed in six patients (5.2% or 0.4 episodes/100 person-days follow-up while patients were on SLED treatment). Citrate accumulation never occurred, even in patients with liver dysfunction. Intravenous calcium for ionized hypocalcemia (, 3.6 mg/dl or , 0.9 mmol/L) was needed in 28 sessions (3.4%); in 8 of these 28 sessions (28.6%), low ionized calcium was already present before SLED start. In 92.6% of treatments, SLED was completed within the scheduled time (median 8 hours). Interruptions of SLED by impending/irreversible clotting were recorded in 19 sessions (2.4%). Blood return was complete in 98% of the cases. In-hospital mortality was 45 of 116 patients (38.8%).Conclusions This study protocol affords efficacious and safe anticoagulation of the SLED circuit, avoiding citrate accumulation and, in most patients, systematic calcium supplementation; it can be implemented with commercial citrate solutions, standard dialysis equipment, on-line produced dialysis fluid, and minimal laboratory monitoring.

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“…Generic severity-of-illness scoring systems (e.g., Acute Physiology and Chronic Health Evaluation-II [APACHE II], Simplified Acute Physiology Score [SAPS], and Logistic Organ Dysfunction Score [LODS]) have not discriminated well in most published studies of ARF (15)(16)(17)(18). Although several authors have proposed disease-specific indices, most have been derived at single centers (19 -22), and few have been validated outside of their original institution (23)(24).…”

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confidence: 99%

Refining Predictive Models in Critically Ill Patients with Acute Renal Failure

Mehta

Pascual²,

Gruta³

et al. 2002

Journal of the American Society of Nephrology

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211

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Abstract. Mortality rates in acute renal failure remain extremely high, and risk-adjustment tools are needed for quality improvement initiatives and design (stratification) and analysis of clinical trials. A total of 605 patients with acute renal failure in the intensive care unit during 1989-1995 were evaluated, and demographic, historical, laboratory, and physiologic variables were linked with in-hospital death rates using multivariable logistic regression. Three hundred and fourteen (51.9%) patients died in-hospital. The following variables were significantly associated with in-hospital death: age (odds ratio [OR], 1.02 per yr), male gender (OR, 2.36), respiratory (OR, 2.62), liver (OR, 3.06), and hematologic failure (OR, 3.40), creatinine (OR, 0.71 per mg/dl), blood urea nitrogen (OR, 1.02 per mg/dl), log urine output (OR, 0.64 per log ml/d), and heart rate (OR, 1.01 per beat/min). The area under the receiver operating characteristic curve was 0.83, indicating good model discrimination. The model was superior in all performance metrics to six generic and four acute renal failurespecific predictive models. A disease-specific severity of illness equation was developed using routinely available and specific clinical variables. Cross-validation of the model and additional bedside experience will be needed before it can be effectively applied across centers, particularly in the context of clinical trials.Acute renal failure (ARF) in critically ill patients is associated with a distressingly high mortality rate (1-3). Despite improvements in intensive care and dialytic technology, particularly with continuous renal replacement therapies, we have not observed meaningful improvements in patient survival over the past three decades (4 -8). In most series, more than 50% of patients with hospital-acquired ARF die before hospital discharge; of those who survive, between 10 and 33% require long-term dialysis (9 -11).Over the past decade, several clinical trials have been conducted, aiming to reduce ARF-associated mortality (12)(13)(14). Most of these studies have unfortunately proved unsuccessful, including relatively large, well-designed trials using pharmacologic agents with strong preclinical data (e.g., atrial natriuretic peptide [ANP]). Among the difficulties in design and analysis of clinical trials in ARF are the lack of a standardized definition of ARF, the heterogeneity of ARF, comorbidity and severity of illness directly influencing mortality, and large variations in the process of care. -24). Moreover, the timing of evaluation (e.g., consultation, initial dialysis procedure) and the population to which the index was applied (e.g., all patients with ARF, only dialyzed patients, etc.) have differed across studies. To prepare for future clinical trials in ARF, it is essential that valid, generalizable models for risk adjustment be developed, both for stratification in patient selection and for covariate adjustment in the event of imbalanced randomization.We evaluated 851 consecutive cases of ARF in the intensive...

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Predicting patient outcome from acute renal failure comparing three general severity of illness scoring systems

Cited by 62 publications

References 41 publications

Predictors of Mortality in Acute Renal Failure in a Developing Country: A Prospective Study

Predictors of Mortality in Acute Renal Failure in a Developing Country: A Prospective Study

Efficacy and Safety of a Citrate-Based Protocol for Sustained Low-Efficiency Dialysis in AKI Using Standard Dialysis Equipment

Refining Predictive Models in Critically Ill Patients with Acute Renal Failure

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