De Mendonca et al identified risk factors for a patient in the intensive care unit (ICU) developing acute renal failure. This can help identify patients who may benefit from more aggressive management. The authors are from multiple hospitals in Europe and Israel.
Criteria for acute renal failure - one or both of the following:
(1) serum creatinine >= 300 µmol/L (3.5 mg/dL)
(2) oliguria or anuria (urine output < 500 mL per day)
Parameters identified by logistic regression:
(1) age
(2) infection on admission
(3) acute cardiovascular failure
(4) cirrhosis
(5) respiratory failure
(6) chronic heart failure
(7) lymphoma or leukemia
|
Parameter |
Finding |
Points |
|
age of the patient |
< 65 years |
0 |
|
|
>= 65 years |
1 |
|
infection on admission |
absent |
0 |
|
|
present |
1 |
|
acute cardiovascular failure |
absent |
0 |
|
|
present |
1 |
|
cirrhosis |
absent |
0 |
|
|
present |
1 |
|
respiratory failure |
absent |
0 |
|
|
present |
1 |
|
chronic heart failure |
absent |
0 |
|
|
present |
1 |
|
lymphoma or leukemia |
absent |
0 |
|
|
present |
1 |
where:
• Acute cardiovascular failure was based on the SOFA score, with hypotension and/or need for vasopressors.
• The odds ratios for each of the parameters ranged from 1.4 to 2.2.
• I am surprised pre-existing renal disease is not included as a parameter.
total score =
= SUM(points for all 7 parameters)
Interpretation:
• minimum number of risk factors: 0
• maximum number of risk factors: 7
• The risk of developing acute renal failure increases as the number of risk factors increases. This corresponds to development of multi-organ failure.
Specialty: Nephrology, Clinical Laboratory
