Early prognostic factors in patients with acute renal failure requiring dialysis.
OBJECTIVE
Despite improvements in renal therapy and technology, the mortality rate of patients with acute renal failure (ARF) remains high. Because ARF is a heterogeneous syndrome, occurring in patients with diverse etiologies and comorbid conditions, predicting its outcome is difficult. This study aims to identify early clinical and laboratory prognostic factors, including acute-phase reactants such as C-reactive protein (CRP), fibrinogen, and albumin, in ARF patients requiring dialysis.


METHODS
From June 2002 to March 2004, 61 patients with ARF requiring dialysis at Chang Gung Memorial Hospital, Chiayi, were prospectively analyzed. For each patient, the worst values of prognostic variables 24 hr before starting dialysis were prospectively assessed.


RESULTS
Oliguria, low plasma fibrinogen levels, hypotension, cardiac disease, and neoplastic disease were statistically significant in predicting hospital mortality. Using Youden's index, the best cut-off value for plasma fibrinogen in predicting mortality was 300 mg/dL with a sensitivity and specificity of 61% and 96%, respectively. Serum CRP and serum albumin were not predictive of hospital mortality.


CONCLUSIONS
Early prognostic factors in predicting mortality for patients with ARF requiring dialysis identified by multivariate logistic regression were oliguria, low plasma fibrinogen, hypotension, cardiac disease, and neoplastic disease. Serum CRP and albumin were not predictive of hospital mortality, whereas a plasma fibrinogen level < or =300 mg/dL had 61% sensitivity and 96% specificity in predicting mortality.
Wang
I-Kuan
IK
Division of Nephrology, Chang Gung Memorial Hospital at Chiayi. ikwang@seed.net.tw
Wang
Shan-Tair
ST
Lin
Chun-Liang
CL
Chen
Te-Chuan
TC
Chang
Hung-Yu
HY
Kuo
Huey-Liang
HL
Chuang
Feng-Rong
FR
D058186:Acute Kidney Injury / Q000097:blood* / Q000628:therapy*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D006435:Renal Dialysis; D013997:Time Factors