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. 2014 Oct 3;9(10):e109649.
doi: 10.1371/journal.pone.0109649. eCollection 2014.

Acute kidney injury enhances outcome prediction ability of sequential organ failure assessment score in critically ill patients

Chih-Hsiang Chang  1 , Pei-Chun Fan  1 , Ming-Yang Chang  1 , Ya-Chung Tian  1 , Cheng-Chieh Hung  1 , Ji-Tseng Fang  1 , Chih-Wei Yang  1 , Yung-Chang Chen  1
Affiliations

Acute kidney injury enhances outcome prediction ability of sequential organ failure assessment score in critically ill patients

Chih-Hsiang Chang et al. PLoS One. .

Abstract

Introduction: Acute kidney injury (AKI) is a common and serious complication in intensive care unit (ICU) patients and also often part of a multiple organ failure syndrome. The sequential organ failure assessment (SOFA) score is an excellent tool for assessing the extent of organ dysfunction in critically ill patients. This study aimed to evaluate the outcome prediction ability of SOFA and Acute Physiology and Chronic Health Evaluation (APACHE) III score in ICU patients with AKI.

Methods: A total of 543 critically ill patients were admitted to the medical ICU of a tertiary-care hospital from July 2007 to June 2008. Demographic, clinical and laboratory variables were prospectively recorded for post hoc analysis as predictors of survival on the first day of ICU admission.

Results: One hundred and eighty-seven (34.4%) patients presented with AKI on the first day of ICU admission based on the risk of renal failure, injury to kidney, failure of kidney function, loss of kidney function, and end-stage renal failure (RIFLE) classification. Major causes of the ICU admissions involved respiratory failure (58%). Overall in-ICU mortality was 37.9% and the hospital mortality was 44.7%. The predictive accuracy for ICU mortality of SOFA (areas under the receiver operating characteristic curves: 0.815±0.032) was as good as APACHE III in the AKI group. However, cumulative survival rates at 6-month follow-up following hospital discharge differed significantly (p<0.001) for SOFA score ≤10 vs. ≥11 in these ICU patients with AKI.

Conclusions: For patients coexisting with AKI admitted to ICU, this work recommends application of SOFA by physicians to assess ICU mortality because of its practicality and low cost. A SOFA score of ≥ "11" on ICU day 1 should be considered an indicator of negative short-term outcome.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Comparison of cumulative survival between patients with and without acute kidney injury (AKI) (p<0.001).
Figure 2
Figure 2. Cumulative survival for patients with coexisting AKI admitted to intensive care units were dichotomized at 10 SOFA points or less, and more than 11 SOFA points (p<0.001).
Figure 3
Figure 3. Box plot graph of APACHE II, APACHE III and SOFA score categorized by different AKI severity based on RIFLE classification.
P<0.001 between groups by one-way analysis of variance (ANOVA).
See this image and copyright information in PMC

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