APACHE III scoring system in critically III patients with acute renal failure requiring dialysis

Background. Despite the widespread availability of dialytic and intensive care unit (ICU) technology, the probability of early mortality in critically ill patients with acute renal failure (ARF) is still high, and the evaluation of the patients' prognosis has been difficult. Acute Physiology and Chronic Health Evaluation III (APACHE III) scoring is a reliable indicator of severity of illness and likelihood of survival in critically ill patients with ARF. We have attempted to determine whether APACHE III scoring can be used to predict prognosis. Methods. A retrospective cohort study evaluated the medical records of 100 consecutive patients in the intensive care units with ARF who required dialysis from January 1997 through December 1998. Results. Of the 100 patients studied, 65 were men and 35 were women. The mean age of survivors and non-survivors was 59.38 ± 20.31 yr and 58.28 ± 20.03 yr, respectively. The overall mortality rate was 71%. There were no significant differences between survivors and non-survivors in terms of age, gender, or indication for dialysis. Death in the majority of patients was related to a higher APACHE III score during the 24 hours immediately preceding the initiation of acute hemodialysis; mortality rates exceeded 86% with an APACHE III score above 90. Conclusion. We conclude that the mortality rate for ARF in ICU patients continues to be high. The APACHE III score, determined at the time of initiation of dialysis for patients with ARF, is a statistically significant predictor of patient survival.