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Abstract: SA-PO145

Simplified Acute Physiology Score II Predicts 4-Year Outcomes in Critically Ill Elderly Patients with AKI

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • Jia, Linpei, Xuanwu Hospital of Capital Medical University, Beijing, China
  • Zhang, Hongliang, the National Natural Science Foundation of China, Beijing, China
  • Jia, Rufu, Cangzhou Central Hospital, Cangzhou, China
Background

Acute kidney injury (AKI) is a serious complication of critically ill elderlies. Several severity scoring systems have been used to predict the prognosis. However, which severity score has the better predictive efficiency in elderlies with AKI is unknown.

Methods

Data of AKI elderlies was extracted from Medical Information Mart for Intensive Care III database. Subjects were divided into three groups, according to 65-75 years, 75 - 85 years and ≥ 85 years. SAPS II, OASIS, MLODS, SIRS and SOFA were compared. The Kaplan-Meier and receiver operating characteristic (ROC) curves were performed to assess the prognostic values.

Results

Totally 10472 AKI elderlies were enrolled. Older patients had higher death rates (Figure A) and shorter survival time (Figure B). SAPS II had the best prognostic value (P < 0.01, Figure C). The AUC of SAPS II (95% CI, 0.676 to 0.694) was significantly the highest (P < 0.01, Table). The cut-off value of SAPS II was 40. Patients with SAPS II < 40 would have a better prognosis than those with SAPS II ≥ 40 (Figure D).

Conclusion

SAPS II could better predict the long-term prognosis of elderly patients with AKI.

Area under receiver operating curve (AUC) of mortality and different severity scores.
 All subjects (N = 10472)AKI stage 1 (N = 3039)AKI stage 2 (N = 4045)AKI stage 3 (N = 3388)
 AUC (95% CI)PAUC (95% CI)PAUC (95% CI)PAUC (95% CI)P
SAPS II0.685 (0.676, 0.694) 0.655 (0.637, 0.672) 0.662 (0.647, 0.676) 0.734 (0.719, 0.749) 
MLODS0.630 (0.620, 0.639)< 0.010.626 (0.608, 0.643)< 0.010.585 (0.570, 0.600)< 0.010.683 (0.667, 0.699)< 0.01
OASIS0.630 (0.620, 0.639)< 0.010.584 (0.566, 0.601)< 0.010.622 (0.607, 0.637)< 0.010.679 (0.663, 0.694)< 0.01
SIRS0.533 (0.523, 0.542)< 0.010.527 (0.509, 0.545)< 0.010.519 (0.503, 0.534)< 0.010.562 (0.546, 0.579)< 0.01
SOFA0.591 (0.582, 0.601)< 0.010.582 (0.565, 0.600)< 0.010.541 (0.525, 0.556)< 0.010.655 (0.638, 0.671)< 0.01

AKI, acute kidney injury; AUC, area under curve; CI, confidence interval; SE, standard error; RDW, red blood cell distribution width; SAPS II, simplified acute physiology and chronic health evaluation III; MLODS, modified logistic organ dysfunction system; SOFA, sequential organ failure assessment; OASIS, oxford acute severity of illness score; SIRS, systemic inflammatory response syndrome.

Comparisons of prognostic values among five severity scores.