A SIMPLE PROGNOSTIC INDEX FOR PATIENTS WITH ACUTE-RENAL-FAILURE REQUIRING DIALYSIS

The probability of death in patients with acute renal failure (ARF) re mains high. A valid prognostic index available on patient admission an d during follow-up could be helpful for decision making. In this study , 94 ARF patients requiring dialysis (not responding to a previous sin gle dose of furosemide 15 mg/kg) were included. On admission, patients were classified according to a Simplified Acute Physiology Score (SAP S) of less than or equal to 15 or > 15. The prognostic value of 11 ris k factors was analyzed. Only 6 in 11 risk factors were significant by univariate analysis: age (> 55 years) (0.02), mechanical ventilation ( 0.008), oliguria (< 500 mL/day during the first 5 days) (0.02), sepsis (0.001), shock (0.007), and serum bilirubin (> 30 mu mol) (0.001). On ly oliguria and sepsis were significant risk factors by multivariate a nalysis. Overall mortality rate was 41%. Mortality rare was higher in patients with SAPS > 15 (65%) than in those with SAPS less than or equ al to 15 (22%) (0.001). Patients with > 3 risk-factors showed a signif icantly higher mortality rate than patients with < 3 risk factors (all patients disregarding SAPS) (0.001). Considering the worst combinatio n of risk factors by univariate analysis, mortality prediction was 56% if oliguria, sepsis, and high serum bilirubin were present and reache d 80% if an older age was added (four risk factors). Ventilation incre ased probability of death to 92% (five risk factors). If all six risk factors were present, the probability rose to 96%. The corresponding o bserved mortality rate was 32% for three risk factors, 70% for four; 8 1% for five and 100% for six risk factors. The results suggest that pr obability of death in ARF requiring dialysis can be correctly estimate d when more than three significant risk factors are present. If confir med, they could avoid using a more complex severity scoring system in patients with ARF requiring dialysis.