[Comparison of two score models in predicting prognosis and renal outcome in acute renal failure].
OBJECTIVE
To compare the value of ATN-ISI (acute tubular necrosis-individual severity index) and APACHE II (acute physiology and chronic health evaluation) score models in predicting mortality and renal outcome in patients with acute renal failure (ARF).


METHODS
422 in-hospital patients with ARF were retrospectively analysed, the value in predicting prognosis and renal outcome of these two score models was compared. Renal outcome was observed three times, i.e. >or= 30 days, >or= 45 days and >or= 60 days after the occurrence of ARF and discriminant analysis was used in the study.


RESULTS
The scores of the two models both correlated significantly with the mortality of patients with ARF. When ATN-ISI scores were >or= 0.85, the mortality was 100% and it was the same with APACHE II when the scores were >or= 35. The areas under ROC curve of APACHE II and ATN-ISI were 0.817 +/- 0.021 and 0.880 +/- 0.018 respectively, suggesting good model discriminantion. For the correctly classificated rate of renal outcome, ATN-ISI was better than APACHE II at any time. When ATN-ISI scores were >or= 0.75, patients were dialysis dependent. When the scores were >or= 0.58 but less than 0.75, the patient's renal function did not recover but was not dialysis dependent; when the scores were < 0.58, the patients's renal function would recover. When APACHE II scores were >or= 26, patients were dialysis dependent. There was no cut-off score point to separate renal function recovery from renal dysfunction. However, when APACHE II scores were <or= 22, 19.6% of the patients had renal dysfunction and 80.4% of them had renal function recovered.


CONCLUSIONS
Both the score models are of value in predicting mortality and renal outcome in patients with ARF. ATN-ISI score model was better than APACHE II.
Zhang
Wenxian
W
Department of Nephrology, Nanfang Hospital, The First Militorry Medical University, Guangzhou 510516, China.
Zhang
Xun
X
Hou
Fanfan
F
Chen
Pingyan
P
D018806:APACHE; D058186:Acute Kidney Injury / Q000175:diagnosis* / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D007677:Kidney Function Tests; D011237:Predictive Value of Tests; D011379:Prognosis; D012720:Severity of Illness Index; D015996:Survival Rate