Evaluation of prognostic indexes in critical acute renal failure patients

Evaluation of prognostic indexes in critical acute renal failure patients

Author Batista, PBP Google Scholar
Neto, M. C. Google Scholar
Santos, OFP dos Google Scholar
Bacelar, ACC Google Scholar
Campos, G. B. Google Scholar
Santos, ESC dos Google Scholar
Institution Sao Rafael Hosp
Universidade Federal de São Paulo (UNIFESP)
Abstract Objective. To study different prognostic indexes in acute renal failure (ARF) patients admitted to an intensive care unit (ICU). Design. Prospective, cohort study. Individual Severity Score-Acute Tubular Necrosis (ISS-ATN) obtained prospectively and retrospectively, Acute Physiologic and Chronic Health Evaluation (APACHE II) Score, APACHE II Risk, Lung Injury Score (LIS), and Number of Organ Failures (NOF) were calculated for each patient. the outcome analyzed was death in the ICU. Discrimination was evaluated by the area under the receiver operator characteristic curve (AUC). for calibration analysis, the chi-square goodness-of-fit test was used to compare predicted mortality, calculated by ISS-ATN (obtained prospectively or retrospectively) and APACHE II risk, with observed mortality. Setting. ICU, Sao Rafael Hospital, Salvador-BA, Brazil. Patients. Seventy-six ARF patients admitted to the ICU within 6 months. Interventions. Surgical and medical procedures. Measurements and Results. the observed AUC was 0.69 for LIS, 0.73 for prospective ISS-ATN, 0.75 for retrospective ISS-ATN, 0.76 for APACHE II Score, 0.78 for APACHE II Risk, and 0.88 for NOF. These areas were significantly different from 0.5 (p <.001). There was no difference between the observed and expected death rate calculated by ISS-ATN. However, APACHE II underestimated the observed mortality (p <.001). Conclusion. the prognostic indexes studied showed good discriminative power. However, APACHE II was not well calibrated in contrast to the good calibration of ISS-ATN.
Keywords acute renal failure
calibration
discrimination
mortality
prognosis
ROC curve
APACHE (Acute Physiologic and chronic health evaluation) II
creatinine
dialysis
diuresis
intensive care unit
lung injury score
prognostic index
respiratory failure
positive end expiratory pressure (PEEP)
death rate
Language English
Date 2004-01-01
Published in Renal Failure. New York: Marcel Dekker Inc, v. 26, n. 5, p. 545-552, 2004.
ISSN 0886-022X (Sherpa/Romeo, impact factor)
Publisher Marcel Dekker Inc
Extent 545-552
Origin http://dx.doi.org/10.1081/JDI-200031755
Access rights Closed access
Type Article
Web of Science ID WOS:000224501400010
URI http://repositorio.unifesp.br/handle/11600/27558

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