Description

The probability of survival in patients with end-stage renal disease requiring dialysis can be predicted from clinical and historical findings.


Parameters:

(1) age

(2) heart failure symptoms

(3) angina or myocardial infarction

(4) arrhythmia

(5) peripheral vascular disease

(6) malignancy

(7) respiratory and neurologic status

(8) hepatic and circulatory status

 

Parameter

Finding

Points

age

<= 50 years

1

 

> 50 and <= 60 years

2

 

> 60 and <= 70 years

3

 

> 70 years

4

heart failure symptoms

on strenuous exercise or prolonged activity

1

 

history of prior heart failure

1

 

on ordinary activity or at rest

2

 

recurrent admissions in heart failure

2

angina or myocardial infarction

new onset or stable angina, or myocardial infarction > 6 months previously

1

 

unstable angina, or myocardial infarct < 6 months previously

2

arrhythmia

treated arrhythmia present

2

peripheral vascular disease

gangrene, inoperable peripheral vascular disease, or surgery for peripheral vascular disease < 6 months previously

2

malignancy

metastatic malignancy, refractory myeloma or blood dyscrasia

2

respiratory and neurological status

requires mechanical ventilation and/or in coma

4

hepatic and circulatory status

severe liver disease and/or shock present

4

 

prognostic score =

= (points for age) + (maximum points for heart failure) + (maximum points for angina_MI) + (points for arrhythmia) + (points for peripheral vascular disease) + (points for malignancy) + (points for respiratory_neurological status) + (points for hepatic_circulatory status)

 

Interpretation:

• minimum score: 1

• maximum score: 22

 

Score

Prognosis

Survival at 100 days

Survival at 1 year

1-4

low risk

98%

90%

5-9

moderate risk

80%

64%

10-22

high risk

48%

48%

(estimated from Figure 1, page 217)


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