Couchoud et al reported a model for predicting 3-month mortality for an elderly patient with end-stage renal disease (ESRD) who is starting dialysis. This can help to determine how to manage the patient. The authors are from multiple institutions in France.
Patient selection: >= 75 years of age with end-stage renal disease
Outcome: 3-month mortality after starting dialysis
Parameters:
(1) age in years
(2) sex
(3) congestive heart failure (CHF) by NYHA stages
(4) peripheral vascular disease (Leriche classification)
(5) dysrhythmia
(6) cancer
(7) severe behavioral disorder
(8) mobility
(9) serum albumin in g/L
|
Parameter |
Finding |
Points |
|
age in years |
75-79.99 years |
0 |
|
|
80-84.99 years |
0 |
|
|
85-89.99 years |
2 |
|
|
>=90 years |
3 |
|
sex |
male |
1 |
|
|
female |
0 |
|
CHF |
no |
0 |
|
|
Stage I or II |
2 |
|
|
Stage III or IV |
4 |
|
peripheral vascular disease |
no |
0 |
|
|
Stage I or II |
0 |
|
|
Stage III or IV |
1 |
|
dysrhythmia |
no |
0 |
|
|
yes |
1 |
|
cancer |
no |
0 |
|
|
yes |
2 |
|
severe behavioral problem |
no |
0 |
|
|
yes |
2 |
|
mobility |
walks without assistance |
0 |
|
|
needs help during transfer |
4 |
|
|
totally dependent for transfer |
9 |
|
serum albumin |
< 25 g/L |
5 |
|
|
25 to 29.99 g/L |
3 |
|
|
30 to 34.99 |
2 |
|
|
>=35 g/L |
0 |
total score =
= SUM(points for all 9 parameters)
Interpretation:
• minimum score: 0
• maximum score: 28
• The higher the score the greater the 3-month mortality.
|
Score |
Risk Mortality |
Percentage |
|
< 12 |
low |
< 20% |
|
12 to 16 |
intermediate |
20-40% |
|
>= 17 |
high |
> 40% |
|
Score |
3-Month Mortality |
|
0 |
1.6 |
|
1 |
1.5 |
|
2 |
4.1 |
|
3 |
4.3 |
|
4 |
4.7 |
|
5 |
7.2 |
|
6 |
8.6 |
|
7 |
10.9 |
|
8 |
12.9 |
|
9 |
13.4 |
|
10 |
18.2 |
|
11 |
19.0 |
|
12 |
23.9 |
|
13 |
25.6 |
|
14 |
25.0 |
|
15 |
32.8 |
|
16 |
37.2 |
|
17 |
41.5 |
|
18 |
41.5 |
|
19 |
55.3 |
|
20 |
56.4 |
|
21 |
64.3 |
|
>= 22 |
83.5 |
Performance:
• The area under the ROC curve is 0.76.
Specialty: Nephrology
