A clinical score to predict mortality in septic acute kidney injury patients requiring continuous renal replacement therapy: the HELENICC score

Abstract

Background: This study aimed to identify predictors of early (7-day) mortality in patients with septic acute kidney injury (AKI) who required continuous renal replacement therapy (CRRT).

Methods: Prospective cohort of 186 septic AKI patients undergoing CRRT at a tertiary hospital, from October 2005 to November 2010.

Results: After multivariate adjustment, five variables were associated to early mortality: norepinephrine utilization, liver failure, medical condition, lactate level, and pre-dialysis creatinine level. These variables were combined in a score, which demonstrated good discrimination, with a C-statistic of 0.82 (95% CI = 0.76-0.88), and good calibration (χ ² = 4.3; p = 0.83). SAPS 3, APACHE II and SOFA scores demonstrated poor performance in this population.

Conclusions: The HEpatic failure, LactatE, NorepInephrine, medical Condition, and Creatinine (HELENICC) score outperformed tested generic models. Future studies should further validate this score in different cohorts.

Keywords: 7-day mortality; Hemodiafiltration; Risk score; Septic acute kidney injury.

Fig. 1

Seven-day mortality (%) in each of HELENICC score’s quartiles (chi-square for trend, p < 0.001)

Fig. 2

Area under the ROC curve for the HELENICC score (0.82; 95% CI = 0.76–0.88); APACHE II score (0.57; 95% CI = 0.48–0.66); SAPS 3 score (0.48; 95% CI = 0.40–0.57) and SOFA score (0.58; 95% CI = 0.49–0.66)