El-Shahawy et al identified risk factors for death in patients with acute tubular necrosis (ATN). These can help identify patients who may benefit from more aggressive management. The authors are from the University of Southern California in Los Angeles.


Patient selection: adults with acute tubular necrosis


Risk factors for mortality within 6 months (in multivariate logistic regression):

(1) Apache II score >= 24

(2) oliguria

(3) need for mechanical ventilation

(4) presence of AIDS

(5) presence of 1 or more organ failures in addition to the renal failure (presence of 2 or more organ failures including renal failure)

(6) presence of significant malignancy


Additional risk factors associated with decreased survival:

(1) presence of sepsis

(2) Apache II 19-23 (39% survival at 6 months in the study group)

(3) need for dialysis


Conditions associated with 100% mortality at 6 months after onset of ATN:

(1) Apache II score >= 24

(2) total of 4 or more organ failures

(3) presence of a significant malignancy


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