Thamer et al developed a score for predicting the risk of short-term mortality for an older adult with advanced renal disease requiring dialysis. This can be an aid to informed consent and decision making by patients. The authors are from Medical Technology and Practice Patterns Institute (Bethesda, Maryland), VA New York Harbor Healthcare System, New York University and University of California at Davis.
Patient selection: adult >=67 years of age requiring dialysis
Outcome: short-term (6-month) mortality
Parameters:
(1) age in years
(2) serum albumin in g/dL
(3) independence in activities of daily living (ADL)
(4) living location
(5) history of cancer
(6) history of heart failure
(7) history of hospitalization during past year (with length of hospitalization based on total days in the hospital)
|
Parameter |
Findings |
Points |
|
age in years |
< 70 years |
0 |
|
|
70 to 84 years |
1 |
|
|
85 to 89 years |
2 |
|
|
>= 90 years |
3 |
|
serum albumin |
>= 3.5 g/dL |
0 |
|
|
< 3.5 g/dL |
1 |
|
activities of daily living |
independence |
0 |
|
|
dependent |
1 |
|
living location |
nursing home |
1 |
|
|
other |
0 |
|
history of cancer |
no |
0 |
|
|
yes |
1 |
|
history of heart failure |
no |
0 |
|
|
yes |
1 |
|
history of hospitalization during past year |
<= 1 hospital stay AND <= 1 month |
0 |
|
|
other |
1 |
total score =
= SUM(points for all 7 parameters)
Interpretation:
• minimum score: 0
• maximum score: 9
• The higher the score the greater the short-term mortality.
|
Score |
6 Month Mortality |
|
0 |
4% |
|
1 |
7% |
|
2 |
12% |
|
3 |
20% |
|
4 |
27% |
|
5 |
35% |
|
6 |
44% |
|
7 |
49% |
|
8 or 9 |
55% |
Performance:
• The area under the ROC curve was 69% in the validation group.
Specialty: Nephrology, Clinical Laboratory
