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Acute Tubular Necrosis Individual Severity Index (ATN-ISI) for Predicting Mortality in a Patient with Acute Tubular Necrosis

Purpose: To predict survival in a patient with acute tubular necrosis using the ATN-ISI index of Liano et al.

Description

Liano et al developed an equation for predicting mortality in a patient with acute tubular necrosis. This can help identify a patient who may need more aggressive therapy or who may considered for novel therapies. The authors are from Hospital Ramon y Cajal in Madrid, Spain.


Parameters (most parameters reflect an organ system failure):

(1) age, in decades

(2) sex

(3) nephrotoxic

(4) oliguria (I assume this also would include anuria)

(5) hypotension

(6) jaundice

(7) coma

(8) consciousness

(9) assisted respiration

 

Parameter

Finding

Points

age

 

=ROUND(B8/10,0)

sex

male

1

 

female

0

nephrotoxic

exposure to nephrotoxin

1

 

not exposed to nephrotoxin

0

oliguria

present

1

 

absent

0

hypotension

systolic blood pressure < 100 mm Hg for > 10 hours regardless of vasoactive medication use

1

 

not hypotensive

0

jaundice

serum bilirubin > 2 mg/dL

1

 

serum bilirubin <= 2 mg/dL

0

coma

present (Glasgow coma scale < 5)

1

 

absent

0

consciousness

normal consciousness

1

 

altered consciousness

0

assisted respiration

on mechanical support

1

 

not on mechanical support

0

 

probability of mortality =

= (0.032 * (points for age in decades)) – (0.086 * (points for sex)) – (0.109 * (points for nephrotoxic)) + (0.109 * (points for oliguria)) + (0.116 * (points for hypotension)) + (0.122 * (points for jaundice)) + (0.150 * (points for coma)) – (0.154 * (points for consciousness)) + (0.182 * (points for assisted respiration)) + 0.21

 

NOTE: In the example on page 546, the patient is listed as oliguric, yet the score reflects absent oliguria (normal urine output). The predicted mortality should be 0.312 rather than 0.203.


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Specialty

Objective

ICD-10