PROGNOSIS OF PATIENTS WITH ACUTE-RENAL-FAILURE REQUIRING DIALYSIS - RESULTS OF A MULTICENTER STUDY

Despite several decades of clinical experience, the mortality rate for patients with acute renal failure (ARF) requiring dialysis remains hi gh, and the evaluation of the patients prognosis has been difficult. T o date, the Acute Physiology and Chronic Health Evaluation II (APACHE II) scoring system has been used more frequently for prediction in stu dies of ARF than any other scoring system, but has not been prospectiv ely validated in controlled multicenter studies of this entity. In a m ulticenter, prospective, controlled trial evaluating the use of biocom patible hemodialysis membranes (BCMs) in patients with ARF, we evaluat ed the extent to which the APACHE II scoring system, based on the phys iological variables in the 24 hours before the onset of dialysis and t he presence or absence of oliguria, is predictive of outcome. Analysis of survival and recovery of renal function for the 153 patients treat ed in this study show that APACHE II scores are predictive both of sur vival and recovery of renal function, whether analyzed separately by t ype of dialysis membrane used (BCM or bioincompatible [BICM]) or for b oth groups combined (all P < 0.01). There was no evidence of a signifi cant center effect or interaction of APACHE II score with dialysis mem brane in our study. After adjusting for the APACHE II score, there was a positive effect of the BCM on both probability of survival (P < 0.0 5) and recovery of renal function (P < 0.01). In patients dialyzed wit h BCMs, oliguria at onset of dialysis had an adverse effect on both su rvival and recovery of renal function (both P < 0.01). Receiver operat or curves (ROCs) using APACHE II score and the use of BCMs in nonoligu ric patients yielded a statistically significant improvement versus th e use of APACHE II score alone in the area under the curve (AUC) for s urvival (0.747 to 0.801; P < 0.05) and recovery of renal function (0.7 12 to 0.775; P < 0.05). We conclude that the use of the APACHE II scor e determined at the time of initiation of dialysis for patients with A RF is a statistically significant predictor of patient survival and re covery of renal function. The use of the APACHE II score measured at t he time of dialysis initiation, especially when modified by the presen ce or absence of oliguria, should help in predicting outcome when eval uating interventions for patients with ARF. (C) 1998 by the National K idney Foundation, Inc.