Outcomes and APACHE II predictions for critically ill patients with acute renal failure requiring dialysis

Background: Despite the widespread availability of dialytic and intensive c are unit technology, the probability of early mortality in critically ill p atients with acute renal failure (ARF) is still high, and the evaluation of the patients' prognosis has been difficult. The Acute Physiology and Chron ic Health Evaluation II (APACHE II) score is a reliable indicator of severi ty of illness and likelihood of survival in critically ill patients with AR E We have attempted to determine whether the APACHE II scoring system can b e used to predict prognosis. Methods: A retrospective cohort study evaluate d the medical records of 100 consecutive patients in intensive care units w ith acute renal failure who required dialysis from January 1997 through Dec ember 1998. Results: Of the 100 patients studied, 65 were men and 35 were w omen. The mean age of survivors and nonsurvivors was 59.4 +/- 20.3 years an d 58.3 +/- 20.0 years. The overall mortality rate was 71%. There were no si gnificant differences between survivors and nonsurvivors in age, gender, or indication for dialysis. The cause of death in the majority of patients wa s related to higher APACHE II score during the 24 hours immediately precedi ng the initiation of acute hemodialysis, and carry mortality rates exceedin g 85% with an APACHE II score of 24 or higher. Conclusion: We conclude that mortality rate for acute renal failure in intensive care unit patients con tinues to be high. The use of the APACHE II score determined at the time of initiation of dialysis for patients with ARF is a statistically significan t predictor of patient survival. There is a significant trend with APACHE I I score for outcome.