Serial APACHE III scoring for acute renal failure in the intensive care unit

Severity stratification and prediction models are important tools for gaugi ng outcomes in critically ill patients. However, most severity scoring syst ems are inaccurate when attempting to predict mortality in individuals with acute renal failure (ARF), including the APACHE (Acute Physiology and Chro nic Health Evaluation) II scoring system. APACHE Ill scoring encompasses a greater array of physiologic parameters that may better correlate with outc ome in ARE We evaluated APACHE II and APACHE III scoring in 27 individuals admitted to the intensive acre unit (ICU) with ARE requiring dialysis. We a lso evaluated the predictive value of serial APACHE Ill scoring on mortalit y Sixteen of the study subjects were discharged alive from the ICU. APACHE II scores for ICU survivors versus nonsurvivors were not significantly diff erent at the outset of dialysis treatment, though they did discriminate bet ween survivors and nonsurvivors at 48 hours (survivors 15 +/- 6.2; nonsurvi vors 18.1 +/- 6.9; p = 0.019). However, average APACHE III scores for survi vors were significantly less than those for nonsurvivors on all days of sco re collection, including at the outset of dialysis (day 0 survivors 94.7 +/ - 22.1; nonsurvivors 106.8 +/- 21.7; p = 0.03). APACHE III scores on day 2 also discriminated between those who recovered renal function (83.6 +/- 16. 7) compared to those who did not (105.6 +/- 21.4) (p = 0.05). Serial APACHE III scoring provided rapid and reproducible scoring that differentiated be tween survivors and nonsurvivors in a group of critically ill patients with ARE This study suggests that further investigations are warranted to confi rm whether serial APACHE III scoring should be considered as an adjunct cli nical tool in caring for individuals with ARF in the ICU.