title: Acute kidney injury enhances outcome prediction ability of sequential organ failure assessment score in critically ill patients.
abstract: BACKGROUND
  Acute kidney injury (AKI) is a common and serious complication in intensive care unit (ICU) patients and also often part of a multiple organ failure syndrome. The sequential organ failure assessment (SOFA) score is an excellent tool for assessing the extent of organ dysfunction in critically ill patients. This study aimed to evaluate the outcome prediction ability of SOFA and Acute Physiology and Chronic Health Evaluation (APACHE) III score in ICU patients with AKI.
  
  
  METHODS
  A total of 543 critically ill patients were admitted to the medical ICU of a tertiary-care hospital from July 2007 to June 2008. Demographic, clinical and laboratory variables were prospectively recorded for post hoc analysis as predictors of survival on the first day of ICU admission.
  
  
  RESULTS
  One hundred and eighty-seven (34.4%) patients presented with AKI on the first day of ICU admission based on the risk of renal failure, injury to kidney, failure of kidney function, loss of kidney function, and end-stage renal failure (RIFLE) classification. Major causes of the ICU admissions involved respiratory failure (58%). Overall in-ICU mortality was 37.9% and the hospital mortality was 44.7%. The predictive accuracy for ICU mortality of SOFA (areas under the receiver operating characteristic curves: 0.815±0.032) was as good as APACHE III in the AKI group. However, cumulative survival rates at 6-month follow-up following hospital discharge differed significantly (p<0.001) for SOFA score ≤10 vs. ≥11 in these ICU patients with AKI.
  
  
  CONCLUSIONS
  For patients coexisting with AKI admitted to ICU, this work recommends application of SOFA by physicians to assess ICU mortality because of its practicality and low cost. A SOFA score of ≥ "11" on ICU day 1 should be considered an indicator of negative short-term outcome.
authors.affiliation: Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Taipei, Taiwan Chang Gung University College of Medicine, Taoyuan, Taiwan; Chang Gung University College of Medicine, Taoyuan, Taiwan.
authors.forename: Chih-Hsiang
authors.initials: CH
authors.lastname: Chang
authors.affiliation: Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Taipei, Taiwan Chang Gung University College of Medicine, Taoyuan, Taiwan; Chang Gung University College of Medicine, Taoyuan, Taiwan.
authors.forename: Pei-Chun
authors.initials: PC
authors.lastname: Fan
authors.affiliation: Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Taipei, Taiwan Chang Gung University College of Medicine, Taoyuan, Taiwan; Chang Gung University College of Medicine, Taoyuan, Taiwan.
authors.forename: Ming-Yang
authors.initials: MY
authors.lastname: Chang
authors.affiliation: Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Taipei, Taiwan Chang Gung University College of Medicine, Taoyuan, Taiwan; Chang Gung University College of Medicine, Taoyuan, Taiwan.
authors.forename: Ya-Chung
authors.initials: YC
authors.lastname: Tian
authors.affiliation: Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Taipei, Taiwan Chang Gung University College of Medicine, Taoyuan, Taiwan; Chang Gung University College of Medicine, Taoyuan, Taiwan.
authors.forename: Cheng-Chieh
authors.initials: CC
authors.lastname: Hung
authors.affiliation: Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Taipei, Taiwan Chang Gung University College of Medicine, Taoyuan, Taiwan; Chang Gung University College of Medicine, Taoyuan, Taiwan.
authors.forename: Ji-Tseng
authors.initials: JT
authors.lastname: Fang
authors.affiliation: Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Taipei, Taiwan Chang Gung University College of Medicine, Taoyuan, Taiwan; Chang Gung University College of Medicine, Taoyuan, Taiwan.
authors.forename: Chih-Wei
authors.initials: CW
authors.lastname: Yang
authors.affiliation: Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Taipei, Taiwan Chang Gung University College of Medicine, Taoyuan, Taiwan; Chang Gung University College of Medicine, Taoyuan, Taiwan.
authors.forename: Yung-Chang
authors.initials: YC
authors.lastname: Chen
mesh_terms: D018806:APACHE; D058186:Acute Kidney Injury / Q000503:physiopathology*; D000368:Aged; D016638:Critical Illness / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000175:diagnosis* / Q000401:mortality; D063305:Organ Dysfunction Scores; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D015996:Survival Rate