The BEST (Beginning and Ending Supportive Therapy) Kidney Investigators identified a number of risk factors associated with mortality in a critically ill patient with acute renal failure. These can help identify a patient who may benefit from more aggressive management. The authors are from multiple institutions from North America, Europe, Australia, and Asia.


Patient selection: critically ill patient with acute renal failure

Risk factors for hospital mortality:

which indicates

(1) use of vasopressors

hypotension and shock

(2) septic shock

bacteremia and shock

(3) cardiogenic shock

cardiac failure

(4) mechanical ventilation

respiratory failure

(5) hepatorenal failure

cirrhosis/hepatic failure



• The odds ratio for each item range from 1.4 to 2.1.


number of risk factors present =

= SUM(number of risk factors present)



• minimum number of risk factors: 0

• maximum number of risk factors: 5

• The risk of mortality increases as the number of organ failures increase.


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