Description

Acute renal failure may develop after surgery and has a relatively high mortality rate. Cioffi et al developed a prognostic index for patients developing postoperative acute renal failure. The study was performed at the University of Vermont.


Parameters for prognostic index:

(1) age of the patient

(2) number of units of RBCs transfused

(3) type of surgery (cardiac and/or vascular surgery)

(4) heart failure

(5) preoperative hypotension

(6) gender

(7) time between onset of renal failure and starting of hemodialysis

 

Parameter

Finding

Points

age of the patient in years

 

(age)

number of RBC units transfused

< 5

1

 

5 – 10

2

 

11 – 20

3

 

> 20

4

cardiac surgery

no

0

 

yes

1

cardiac failure

no

0

 

yes

1

gender

female

0

 

male

1

vascular surgery other than abdominal aortic aneurysm

no

0

 

yes

1

interval in days from onset of acute renal failure to hemodialysis

 

(days)

preoperative hypotension

no

0

 

yes

1

 

where:

• For blood transfused, I've assumed that 0 units transfused gets 1 point.

 

linear discriminant function =

= (0.034 * (points for age)) - (0.472 * (points for number units transfused)) + (1.43 * (points for cardiac surgery)) - (1.21 * (points for cardiac failure)) + (1.44 * (points for gender)) + (1.09 * (points for vascular surgery)) - (0.050 * (points for interval in days before dialysis)) - (0.75 * (points for preoperative hypotension)) + 3.19

 

Interpretation:

• minimum score in study population: –2.04

• maximum score in study population: +3.95

• A score > 0.669 was usually associated with survival, while a negative score was usually associated with death.

 

Score

Risk

< -0.423

high risk (no survivors)

-0.423 to 1.76

intermediate risk

> 1.76

low risk

from page 209

 

Limitations:

• The index was developed in 1984 and survival has probably improved due to newer treatment modalities.


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