Groeneveld et al studied factors associated with mortality from acute renal failure (ARF) in the medical intensive care unit (ICU). This can help identify high risk patients, who might benefit from preventive strategies and more aggressive therapy. The authors are from the Free University Hospital in Amsterdam, The Netherlands.
Risk factors associated with mortality from acute renal failure using multivariate analysis:
(1) onset of cardiovascular failure relative to the onset of ARF
(2) presence of pulmonary failure before the onset of ARF
(3) treatment modalities for the renal failure
(4) age
(5) history of chronic renal failure
Of interest is that the presence or absence of sepsis did not contribute to the analysis.
Criteria used (Table 1, page 603):
(1) cardiovascular failure: mean arterial pressure <= 50 mm Hg; need for volume loading and/or vasoactive drugs to maintain systolic blood pressure above 100 mm Hg; heart rate <= 50 beats per minute; ventricular tachycardia or fibrillation; cardiac arrest; acute myocardial infarction
(2) pulmonary failure: respiratory rate <= 5 breaths per minute or >= 50 breaths per minute; mechanical ventilation for 3 or more days, with FIO2 > 0.4 and/or with PEEP > 5 cm H2O.
|
Parameter
|
Finding
|
Points
|
|
onset of cardiovascular failure before onset ARF
|
present
|
1
|
|
|
absent (none or after)
|
0
|
|
onset of cardiovascular failure after onset ARF
|
present
|
1
|
|
|
absent (none or prior to)
|
0
|
|
pulmonary failure before onset of ARF
|
present
|
1
|
|
|
absent (none or after onset)
|
0
|
|
treatment modalities
|
combined modalities (two or more)
|
1
|
|
|
single modality (hemodialysis, continuous arteriovenous hemofiltration, peritoneal dialysis)
|
0
|
|
age in years
|
|
(age)
|
|
history of chronic renal failure
|
present
|
1
|
|
|
absent
|
0
|
X =
= (4.69 * (points for cardiovascular failure after ARF)) + (3.09 * (points for pulmonary failure)) + (2.49 * (points for cardiovascular failure before ARF)) + (2.36 * (points for combined therapy)) + (0.065 * (age in years)) - (3.05 * (points for chronic renal failure)) – 7.93
probability of mortality =
= EXP(X) / (1 + EXP(X))
