Maccariello Elizabeth R, Valente Carla, Nogueira Lina, Ismael Márcia, Valença Ricardo V R, Machado José E S, Rocha Eduardo, Soares Márcio
Hospital Universitário Antônio Pedro, Niterói.
NepHro Consultoria.
Rev Bras Ter Intensiva. 2008 Jun;20(2):115-23.
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).
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.
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.
Organ dysfunction, general and renal-specific severity-of-illness scores were inaccurate in predicting outcome in ICU patients in need for RRT.
对于急性肾损伤（AKI）患者的预后评分尚无共识。本研究的目的是评估六种预后评分在预测AKI患者医院死亡率及肾脏替代治疗（RRT）需求方面的表现。
对三家三级医疗机构重症监护病房（ICU）收治的、在32个月期间因AKI需要RRT的患者进行前瞻性队列研究。排除终末期肾病患者以及ICU住院时间<24小时的患者。使用ICU入院后首个24小时的数据计算序贯器官衰竭评估（SOFA）II和急性生理与慢性健康状况评分系统（APACHE）II评分，使用RRT开始后首个24小时的数据计算Logistic器官功能障碍（LOD）、器官功能障碍评分（ODIN）、利亚尼奥（Liaño）和梅塔（Mehta）评分。使用受试者工作特征曲线下面积（AUROC）评估区分度，使用Hosmer-Lemeshow拟合优度检验评估校准度。医院死亡率是感兴趣的终点。
共评估了467例患者。医院死亡率为75%。SOFA II和APACHE II评分的平均值分别为48.5±11.2分和27.4±6.3分，LOD评分中位数为7（5-8）分。除梅塔评分（p = 0.001）外，所有模型的校准均合适。然而，区分度均不令人满意；AUROC范围从ODIN评分的0.60到SOFA II和梅塔评分的0.72。此外除梅塔评分外，所有模型均倾向于低估医院死亡率。
器官功能障碍、一般及肾脏特异性疾病严重程度评分在预测需要RRT的ICU患者预后方面不准确。
