Discriminant Function of Foley et al for Prediction of Early Death in Patients Starting Maintenance Dialysis

Description

Patients starting dialysis were studied to determine which variables were associated with survival at 6 months after starting maintenance dialysis. Variables were studied using univariate and multivariate analysis, and a simplified scoring system was developed.

NOTE: This study preceded that of Barrett et al (next); the simplified scoring system is similar and the papers share many of the same authors.

Stepwise Discriminant Function

Target: Patients alive or dead at 6 months after starting dialysis.

Variable	Coefficient
ventilated and/or comatose	2.99
sepsis and/or hepatic failure	2.66
advanced neoplasia	1.17
age per stratum	0.25
severe peripheral vascular disease	0.90
ischemic heart disease	0.85
cardiac failure	0.68
constant	-10.72

(Table 4, page 840)

where:

• age stratum: <= 50 is 1, 51-60 is 2, 61-70 is 3, and > 70 is 4

• each of the variables is defined on page 837

• variable value = 0 if absent, 1 if present

discriminant score =

= SUM((coefficient) * (variable value))

Interpretation:

• minimum score: -1.22

• maximum score: +8.87

• The higher the score, the worse the prognosis.

Score	6 Month Mortality Rate
<= -0.5	1.8%

>= 1.68	100%

Simplified Scoring System

Parameter	Finding	Points
age	<= 50 years	1
	51 - 60 years	2
	61 - 70 years	3
	> 70 years	4
cardiac failure	moderate	1
	severe	2
ischemic heart disease	moderate	1
	severe	2
dysrhythmia requiring therapy	present	2
peripheral vascular disease	severe	2
malignancy	advanced	2
respiratory and neurological status	requires mechanical ventilation and/or in coma	4
sepsis and liver status	sepsis and/or hepatic failure	4

(Table 6, page 842)

prognostic score =

= (points for age) + (points for cardiac failure) + (points for ischemic heart disease) + (points for dysrhythmia) + (points for peripheral vascular disease) + (points for malignancy) + (points for respiratory_neurological status) + (points for sepsis_liver status)

Interpretation:

• minimum score: 1

• maximum score: 22

• The higher the score, the worse the prognosis.

Score	6 Month Mortality Rate
1-4	4%
5-6	33%
7-8	47%
9 - 22	90%
10-22	100%

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Discriminant Function of Foley et al for Prediction of Early Death in Patients Starting Maintenance Dialysis

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