Parameters:
(1) laboratory evidence of TLS
(2) serum creatinine
(3) cardiac arrhythmias
(4) seizures
Laboratory evidence of TLS:
(1) elevation serum uric acid (>= 8 mg/dL OR 25% increase from baseline)
(2) elevation of serum potassium (>= 6 mmol/L OR 25% increase from baseline)
(3) elevation of serum phosphorus (>= 6.5 mg/dL OR 25% increase from baseline)
(4) decrease in serum calcium (<= 7 mg/dL OR 25% decrease from baseline)
Grade 0 TLS:
(1) absence of laboratory evidence of TLS
(2) serum creatinine <= 1.5 times the upper limit of normal
(3) no cardiac arrhythmias
(4) no seizure activity
Grade I TLS:
(1) laboratory evidence of TLS
(2) serum creatinine 1.5 times the upper limit of normal (meeting this criteria would be difficult since it is so specific)
(3) minor cardiac arrhythmias present with no need for intervention
(4) no seizure activity
Grade II TLS:
(1) laboratory evidence of TLS
(2) serum creatinine 1.51 to 3.0 times the upper limit of normal
(3) mild cardiac arrhythmias present with no need for an urgent intervention
(4) 1 brief, generalized seizure OR seizures controlled with medications OR infrequent motor seizures
Grade III TLS:
(1) laboratory evidence of TLS
(2) serum creatinine 3.01 to 6.0 times the upper limit of normal
(3) symptomatic cardiac arrhythmias present; incompletely controlled by medical therapy or controlled with a device
(4) seizures with impaired consciousness OR poorly controlled by medications OR generalized seizures despite medical therapy
Grade IV TLS:
(1) laboratory evidence of TLS
(2) serum creatinine > 6 times the upper limit of normal
(3) life threatening cardiac arrhythmias with CHF or shock
(4) status epilepticus
Grade V TLS:
(1) laboratory evidence of TLS
(2) death due to TLS (from combination of cardiac, metabolic and other factors)
