Malhotra et al reported a score for predicting acute kidney injury (AKI) in a patient in the intensive care unit. This can help to identify a patient who may benefit from more aggressive management. The authors are from the University of California San Diego, the Mayo Clinic and Universite de Montreal.
Patient selection: in intensive care unit
Parameters from within 48 hours of ICU admission:
(1) chronic kidney disease
(2) chronic liver disease
(3) congestive heart failure
(4) hypertension
(5) atherosclerotic coronary vascular disease
(6) arterial pH
(7) exposure to nephrotoxin(s)
(8) sepsis or severe infection
(9) mechanical ventilation
(10) anemia
|
Parameter
|
Finding
|
Points
|
|
chronic kidney disease
|
no
|
0
|
|
|
yes
|
2
|
|
chronic liver disease
|
no
|
0
|
|
|
yes
|
2
|
|
congestive heart failure
|
no
|
0
|
|
|
yes
|
2
|
|
hypertension
|
no
|
0
|
|
|
yes
|
2
|
|
atherosclerotic CVD
|
no
|
0
|
|
|
yes
|
2
|
|
arterial pH
|
> 7.3
|
0
|
|
|
<= 7.3
|
3
|
|
exposure to nephrotoxin(s)
|
no
|
0
|
|
|
yes
|
3
|
|
sepsis or severe infection
|
no
|
0
|
|
|
yes
|
2
|
|
mechanical ventilation
|
no
|
0
|
|
|
yes
|
2
|
|
anemia
|
no
|
0
|
|
|
yes
|
1
|
total score =
= SUM(points for all 10 parameters)
Interpretation:
• minimum score: 0
• maximum score: 21
• The optimal cutoff value for increased risk is >= 5 points.
Performance:
• The area under the ROC curve was 0.79 in the development and 0.81 in the validation cohorts.
