Bullock et al identified factors which could be used to predict the mortality risk in patients with acute renal failure. These generally reflect the number of organ failures experienced by the patient. The authors are from Hennepin County Medical Center and the University of Minnesota in Minneapolis.
Patient inclusion:
(1) serum creatinine >= 2.5 mg/dL
(2) renal failure for < 6 weeks (acute)
Parameters:
(1) clinical presentation factors associated with urine output (CP1 and CP2)
(2) pulmonary complications (aspiration pneumonia, respiratory failure, respiratory arrest, ARDS)
(3) age of the patient in years
(4) jaundice (serum bilirubin >= 2.5 mg/dL)
(5) cardiovascular complications (congestive heart failure, pulmonary edema, cardiac arrhythmias, acute myocardial infarction, cardiac arrest)
(6) hypercatabolism
|
Parameter |
Finding |
Points |
|
CP1 |
nonoliguric (> 450 mL urine output per day) |
1 |
|
|
oliguric (50 – 450 mL urine output per day) |
-1 |
|
|
anuric (< 50 mL urine output per day) |
0 |
|
CP2 |
nonoliguric |
0 |
|
|
oliguric |
-1 |
|
|
anuric |
1 |
|
age in years |
|
(age) |
|
pulmonary complications |
absent |
0 |
|
|
present |
1 |
|
jaundice |
absent |
0 |
|
|
present |
1 |
|
cardiovascular complications |
absent |
0 |
|
|
present |
1 |
|
hypercatabolism |
absent |
0 |
|
|
present |
1 |
Q =
= (0.822 * ((value for CP2) + 0.100)) - (0.687 * ((value for CP1) + 0.037)) + (1.053 * ((value for pulmonary complications) - 0.087)) + (0.050 * ((value for age) – 61.1)) + (0.7 * ((value for jaundice) + 0.143)) + (0.608 * ((value for cardiovascular complications) - 0.247)) + (0.365 * ((value for hypercatabolism) + 0.303)) –1.765
probability of death =
= 1 / (1 + EXP((-1) * Q))
The prediction model accounted for 77% of the patient mortality in the series.
Limitation:
• The paper was written in 1985, and patient management has improved since then. There is a good chance that the probability estimates are higher than under current conditions.
Specialty: Nephrology, Clinical Laboratory
