Uso do escore prognóstico APACHE II e ATN-ISS em insuficiência renal aguda tratada dentro e fora da unidade de terapia intensiva

• Autor(a) principal: Fernandes, Natália Maria da Silva
• Data de Publicação: 2009
• Outros Autores: Pinto, Patrícia dos Santos, Lacet, Thiago Bento de Paiva, Rodrigues, Dominique Fonseca, Bastos, Marcus Gomes [UNIFESP], Stella, Sérgio Reinaldo [UNIFESP], Cendoroglo Neto, Miguel [UNIFESP]
• Tipo de documento: Artigo
• Idioma: por
• Título da fonte: Repositório Institucional da UNIFESP
• Texto Completo: http://dx.doi.org/10.1590/S0104-42302009000400019; http://repositorio.unifesp.br/handle/11600/4771
• topic: APACHE II; ATN-ISS; Acute Renal Failure; Intensive Care Unit; APACHE II; ATN-ISS; Insuficiência renal aguda; Unidade de terapia intensiva

INTRODUCTION: Acute renal failure (ARF) remains highly prevalent with a high rate of morbidity and mortality. OBJECTIVE: of this study was to compare use of the APACHE II scoring prognosis with that of the ATN-ISS to determine whether the APACHE II could be used for patients with ARF outside the ICU. METHODS: For this purpose,, 205 patients with ARF were accompanied in a prospective cohort. Demographic data, preexisting conditions, organ failure and characteristics of ARF were analyzed. The prognostic scores were performed with the assessment of a nephrologist. RESULTS: The mean age was 52 ± 18 years, 50% were male, 69% were white, 45% were treated in ICU and 55% in other units. Mortality in the ICU group was 85% and in the non-ICU group 18%. Factors that correlated with higher mortality were more prevalent in the ICU group: age, male, hospitalization with ARF, organ failure, sepsis, septic IRA, oliguria and need of dialysis. Overall, the prognostic markers were the same for both the ICU and non-ICU groups. The discrimination with the APACHE II was similar in both, ICU and non-ICU groups and calibration was better in the non-ICU group. The ATN-ISS achieved good discrimination in both the ICU and non-ICU groups, but, regarding calibration, there was a discreet over estimating of mortality in the non-ICU group. The ATN-ISS showed a greater capacity for discrimination than the APACHE II in both the ICU and non-ICU groups. CONCLUSION: It was concluded that the APACHE II and ATN-ISS scores could be used for stratification of risk in patients with ARF treated outside of the ICU in Brazil.