Lange et al identified patients with a poor prognosis who required dialysis for acute renal failure following open heart surgery. This can help identify patients who require more aggressive management. The authors are from Abbott Northwestern Hospital and the University of Minnesota in Minneapolis.


NOTE: This basically reflects prognosis of multi-organ failure in the post-operative critical care patient.


Inclusion criteria:

(1) adults age >= 18 years

(2) absence of chronic renal failure requiring hemodialysis prior to surgery

(3) postoperative survival for > 48 hours after surgery

(4) acute renal failure requiring dialysis

(5) status post open heart surgery (coronary artery bypass, valve replacement, aortic repair)


Postoperative complications (other than the acute renal failure):

(1) respiratory failure (use of mechanical ventilatory support)

(2) infection (administration of intravenous antibiotics for a body temperature > 38.5°C associated with bacteriologic or radiologic evidence of infection)

(3) central nervous system dysfunction (inability of the patient to respond appropriately to verbal commands, indicating stupor or coma)

(4) hypotension (use of intravenous inotropic drugs for systolic arterial blood pressure < 90 mm Hg)

(5) bleeding (clinically detectable hemorrhage during the preceding 24 hours requiring red blood cell transfusion)

(6) jaundice (total serum bilirubin > 5 mg/dL, serving as a marker for liver failure)


Criteria for poor outcome (nonsurvivor) - one or more of the following:

(1) >= 3 complications prior to first hemodialysis AND complications persisting for next 48 hours

(2) hypotension before first hemodialysis AND hypotension persisting for next 48 hours

(3) central nervous system dysfunction 48 hours after first hemodialysis



• The criteria correctly classified 92% (33 of 36) of patients in study set.



• The study is over 15 years old, and some patients may have a better prognosis than predicted here.


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