Evaluation of prognostic indexes in critical acute renal failure patients.
OBJECTIVE
To study different prognostic indexes in acute renal failure (ARF) patients admitted to an intensive care unit (ICU).


METHODS
Prospective, cohort study. Individual Severity Score-Acute Tubular Necrosis (ISS-ATN) obtained prospectively and retrospectively, Acute Physiologic and Chronic Health Evaluation (APACHE II) Score, APACHE II Risk, Lung Injury Score (LIS), and Number of Organ Failures (NOF) were calculated for each patient. The outcome analyzed was death in the ICU. Discrimination was evaluated by the area under the receiver operator characteristic curve (AUC). For calibration analysis, the chi-square goodness-of-fit test was used to compare predicted mortality, calculated by ISS-ATN (obtained prospectively or retrospectively) and APACHE II risk, with observed mortality.


METHODS
ICU, São Rafael Hospital, Salvador-BA, Brazil.


METHODS
Seventy-six ARF patients admitted to the ICU within 6 months.


METHODS
Surgical and medical procedures.


RESULTS
The observed AUC was 0.69 for LIS, 0.73 for prospective ISS-ATN, 0.75 for retrospective ISS-ATN, 0.76 for APACHE II Score, 0.78 for APACHE II Risk, and 0.88 for NOF. These areas were significantly different from 0.5 (p < .001). There was no difference between the observed and expected death rate calculated by ISS-ATN. However, APACHE II underestimated the observed mortality (p < .001).


CONCLUSIONS
The prognostic indexes studied showed good discriminative power. However, APACHE II was not well calibrated in contrast to the good calibration of ISS-ATN.
Batista
Paulo Benigno Pena
PB
Nephrology and Hemodialysis Service, São Rafael Hospital, Salvador, Bahia, Brazil. pbenigno@terra.com.br
Cendorogolo Neto
Miguel
M
dos Santos
Oscar Fernando Pavão
OF
Carvalho Bacelar
Ana Clarissa
AC
Batista Campos
Gervásio
G
dos Santos
Elise Schaer Carvalho
ES
D018806:APACHE; D058186:Acute Kidney Injury / Q000401:mortality*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies