title: Performance of six prognostic scores in critically ILL patients receiving renal replacement therapy.
abstract: OBJECTIVE
  There is no consensus about prognostic scores for use in patients with acute kidney injury (AKI). The aim of this study was to evaluate the performance of six prognostic scores in predicting hospital mortality in patients with AKI and need for renal replacement therapy (RRT).
  
  
  METHODS
  Prospective cohort of patients admitted to the intensive care units (ICU) of three tertiary care hospitals that required RRT for AKI over a 32-month period. Patients with end-stage renal disease and those with ICU stay < 24h were excluded. Data from the first 24h of ICU admission were used to calculate SAPS II and APACHE II scores, and data from the first 24h of RRT were used in the calculation of LOD, ODIN, Liaño and Mehta scores. Discrimination was evaluated using the area under ROC curve (AUROC) and calibration using the Hosmer-Lemeshow goodness-of-fit test. The hospital mortality was the end-point of interest.
  
  
  RESULTS
  467 patients were evaluated. Hospital mortality rate was 75%. Mean SAPS II and APACHE II scores were 48.5 ±11.2 and 27.4 ± 6.3 points, and median LOD score was 7 (5-8) points. Except for Mehta score (p = 0.001), calibration was appropriate in all models. However, discrimination was uniformly unsatisfactory; AUROC ranged from 0.60 for ODIN to 0.72 for SAPS II and Mehta scores. In addition, except for Mehta, all models tended to underestimate hospital mortality.
  
  
  CONCLUSIONS
  Organ dysfunction, general and renal-specific severity-of-illness scores were inaccurate in predicting outcome in ICU patients in need for RRT.
authors.affiliation: Hospital Universitário Antônio Pedro, Niterói.
authors.forename: Elizabeth R
authors.initials: ER
authors.lastname: Maccariello
authors.affiliation: NepHro Consultoria.
authors.forename: Carla
authors.initials: C
authors.lastname: Valente
authors.affiliation: NepHro Consultoria.
authors.forename: Lina
authors.initials: L
authors.lastname: Nogueira
authors.affiliation: NepHro Consultoria.
authors.forename: Márcia
authors.initials: M
authors.lastname: Ismael
authors.affiliation: NepHro Consultoria.
authors.forename: Ricardo V R
authors.initials: RV
authors.lastname: Valença
authors.affiliation: NepHro Consultoria.
authors.forename: José E S
authors.initials: JE
authors.lastname: Machado
authors.affiliation: NepHro Consultoria.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Rocha
authors.affiliation: NepHro Consultoria.
authors.forename: Márcio
authors.initials: M
authors.lastname: Soares