Floege et al developed a risk score for predicting mortality in a patient undergoing hemodialysis. This can help to identify a patient who may benefit from more aggressive management. The authors are from multiple institutions in Europe and the United States.
Patient selection: adult on hemodialysis in Europe
Outcome: 1-year all-cause mortality
Parameters:
(1) age in years
(2) history of cardiovascular disease (CVD)
(3) history of cancer
(4) body mass index in kilograms per square meter
(5) vascular access for hemodialysis
(6) actual blood flow in mL per minute
(7) hemoglobin in g/dL
(8) serum ferritin in µg/L
(9) C-reactive protein (CRP) in mg/L
(10) serum albumin in g/L
(11) serum creatinine in µmol/L
(12) serum total calcium in mmol/L
|
Parameter |
Findings |
Points |
|
age in years |
<= 39 years |
-5 |
|
|
40 to 49 years |
-2 |
|
|
50 to 59 years |
0 |
|
|
60 to 69 years |
2 |
|
|
70 to 79 years |
4 |
|
|
>= 80 years |
6 |
|
history of CVD |
no |
0 |
|
|
yes |
2 |
|
history of cancer |
no |
0 |
|
|
yes |
4 |
|
BMI |
< 18.5 |
2 |
|
|
18.5 to 24.99 |
0 |
|
|
25.0 to 29.99 |
0 |
|
|
>= 30.0 |
-1 |
|
vascular access |
fistula/graft. no change |
0 |
|
|
catheter, no change |
2 |
|
|
fistula/graft to catheter |
2 |
|
|
catheter to fistula/graft |
1 |
|
blood flow |
< 267 |
0 |
|
|
267 to 298.9 |
-1 |
|
|
299 to 331.9 |
-1 |
|
|
>= 332 |
-1 |
|
hemoglobin |
< 10 g/dL |
2 |
|
|
10 to 11.9 g/dL |
0 |
|
|
>= 12 g/dL |
-1 |
|
serum ferritin |
< 500 |
-1 |
|
|
>= 500 |
0 |
|
CRP |
< 2.6 |
0 |
|
|
2.6 to 6.99 |
1 |
|
|
7.0 to 18.19 |
3 |
|
|
>= 18.2 |
5 |
|
serum albumin |
< 35 |
3 |
|
|
>= 35 |
0 |
|
serum creatinine |
< 431 |
2 |
|
|
431 to 538.9 |
1 |
|
|
539 to 672.9 |
0 |
|
|
>= 673 |
0 |
|
serum total calcium |
< 2.1 |
1 |
|
|
2.1 to 2.59 |
0 |
|
|
>= 2.6 |
3 |
total score =
= SUM(points for all 12 parameters)
Interpretation:
• minimum score: -9
• maximum score: 31
• The higher the score the greater the 1-year all-cause mortality.
|
Score |
Mortality |
|
-9 to 1 |
(0.4515 * (score)) + 4.558 |
|
1 to 25 |
(0.1409 * ((score)^2)) + (0.0578 * (score)) + 4.622 |
Performance:
• The area under the ROC curve is approximately 0.75.
Specialty: Nephrology, Clinical Laboratory
