Chertow et al identified factors associated with mortality in critically-ill patients who develop acute tubular necrosis (ATN). These can help to identify a patient who may benefit from more aggressive management. The authors are from Brigham and Women's Hospital, Cleveland Clinic Foundation, Stanford University, Scios, Inc., and the Auriculin Anaritide Acute Renal Failure Study Group.


Subjects: mean age 62 with 25% >= 75 years of age with 85% in the ICU


Risk factors for mortality from multivariable proportional hazards regression analysis:

(1) male gender

(2) acute myocardial infarction (AMI)

(3) oliguria (average urine output < 400 mL per day at time of entry)

(4) acute stroke or seizure

(5) mechanical ventilation

(6) metabolic acidosis

(7) chronic immunosuppression

(8) hyperbilirubinemia (relative risk increased by 1.06 per 1 mg/dL increase)



• Hypoalbuminemia had a p value 0.08 in the model.

• In a multivariable logistic regression analysis, the first 6 items were significant. In addition, a history of hypertension was associated with a reduced risk of mortality.

• A total serum bilirubin of 11 mg/dL to reach a relative risk of 1.9, comparable to mechanical ventilation.

• Most of the risk factors reflect an organ failure.


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