Paganini et al developed a model for predicting mortality in an ICU patient with acute renal failure requiring dialysis. This can help identify patients who may require more aggressive management. The authors are from the Cleveland Clinic.
Patient selection: ICU patient with acute renal failure requiring dialysis
Parameters:
(1) gender of the patient
(2) intubation and mechanical ventilation
(3) hematologic disorder (platelet count < 50,000 per µL OR white blood cell count < 2,500 per µL OR bleeding diathesis)
(4) serum total bilirubin
(5) recent surgery
(6) number of organ failures
(7) change in serum BUN from admission (current BUN minus admission BUN)
(8) serum creatinine
|
Parameter |
Finding |
Points |
|---|---|---|
|
gender |
female |
0 |
|
|
male |
2 |
|
mechanical ventilation |
no |
0 |
|
|
yes |
3 |
|
hematologic disorder |
no |
0 |
|
|
yes (see above) |
3 |
|
serum bilirubin |
<= 2 mg/dL |
0 |
|
|
> 2 mg/dL |
3 |
|
recent surgery |
no |
1 |
|
|
yes |
0 |
|
number of organ failures |
1 (renal) |
0 |
|
|
2 or 3 |
2 |
|
|
>= 4 (up to 7) |
3 |
|
change in serum BUN |
< 0 mg/dL |
0 |
|
|
0 to 50 mg/dL |
1 |
|
|
> 50 mg/dL |
2 |
|
serum creatinine |
<= 2.0 mg/dL |
3 |
|
|
2.01 to 5 mg/dL |
1 |
|
|
> 5 mg/dL |
0 |
where:
• Items 2, 3, 4 and acute renal failure indicate organ failures. These need to correlate with the number of organ failures reported.
• A low serum creatinine is associated with increased mortality. This may reflect low muscle mass (advanced age, malnutrition, other).
• Organ failures: renal, cardiac, respiratory, GI, neurologic, liver, and hematologic (see Table 2, page 208)..
total score =
= SUM(points for all 8 parameters)
Interpretation:
• minimum score: 0
• maximum score: 20
• The higher the score the greater the risk of hospital mortality.
|
Total Score |
Mortality |
|---|---|
|
0 to 4 |
24% |
|
5 to 7 |
49% |
|
8 to 14 |
75% |
|
15 to 20 |
89% |
Purpose: To evaluate a patient in the ICU with acute renal failure requiring dialysis using the mortality model of Paganini et al.
Specialty: Nephrology, Clinical Laboratory
Objective: severity, prognosis, stage
ICD-10: N17,
