Key result
New 11-variable equation predicts CRRT mortality with ~0.75 AUROC, outperforming SOFA and APACHE II.
Why the study?
Critically ill patients receiving continuous RRT have high mortality, and predicting their mortality risk is difficult.
Does a newly developed 11-variable equation improve mortality risk prediction compared to SOFA and APACHE II scores in critically ill patients on CRRT?
Cohort (n=2,214)
Does a newly developed 11-variable equation improve mortality risk prediction compared to SOFA and APACHE II scores in critically ill patients on CRRT?
Effect estimate: AUROC 0.75, 0.74, and 0.73
A newly developed 11-variable equation provides superior mortality prediction compared to standard SOFA and APACHE II scores for critically ill patients on continuous renal replacement therapy.
May aid short-term mortality prediction in CRRT patients; hypothesis-generating and requires prospective validation before clinical adoption.
Background: Predicting the risk of death in patients admitted to the critical care unit facilitates appropriate management. In particular, among patients who are critically ill, patients with continuous RRT (CRRT) have high mortality, and predicting the mortality risk of these patients is difficult. The purpose of this study was to develop models for predicting the mortality risk of patients on CRRT and to validate the models externally. Methods: A total of 699 adult patients with CRRT who participated in the VolumE maNagement Under body composition monitoring in critically ill patientS on CRRT (VENUS) trial and 1515 adult patients with CRRT in Seoul National University Hospital were selected as the development and validation cohorts, respectively. Using 11 predictor variables selected by the Cox proportional hazards model and clinical importance, equations predicting mortality within 7, 14, and 28 days were developed with development cohort data. Results: The equation using 11 variables had area under the time-dependent receiver operating characteristic curve (AUROC) values of 0.75, 0.74, and 0.73 for predicting 7-, 14-, and 28-day mortality, respectively. All equations had significantly higher AUROCs than the Sequential Organ Failure Assessment (SOFA) and Acute Physiology and Chronic Health Evaluation II (APACHE II) scores. The 11-variable equation was superior to the SOFA and APACHE II scores in the integrated discrimination index and net reclassification improvement analyses. Conclusions: The newly developed equations for predicting CRRT patient mortality showed superior performance to the previous scoring systems, and they can help physicians manage patients.
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Kang et al. (2022) conducted a cohort in Critically ill patients on continuous renal replacement therapy (CRRT) (n=2,214). 11-variable mortality prediction equation vs. SOFA and APACHE II scores was evaluated on Mortality within 7, 14, and 28 days (AUROC 0.75, 0.74, and 0.73). An 11-variable equation predicted 7-, 14-, and 28-day mortality in CRRT patients with AUROCs of 0.75, 0.74, and 0.73, respectively, outperforming SOFA and APACHE II scores.
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