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Investigate predictive capacity of in-hospital mortality of four severity score systems on critically ill patients with acute kidney injury
  1. Yu Gong1,
  2. Feng Ding2,
  3. Fen Zhang3,
  4. Yong Gu2
  1. 1 Department of Internal Medicine, Division of Nephrology, Shanghai Municipal Eighth People’s Hospital, Shanghai, China
  2. 2 Huashan Hospital, Fudan University, Shanghai, China
  3. 3 School of Public Health, Fudan University, Shanghai, China
  1. Correspondence to Dr Yu Gong, Department of Internal medicine, Divisionof Nephrology, Shanghai MunicipalEighth People’s Hospital, , Shanghai, China; gyfd66{at}


Although significant improvements have been achieved in the renal replacement therapy of acute kidney injury (AKI), the mortality of patients with AKI remains high. The aim of this study is to prospectively investigate the capacity of Acute Physiology and Chronic Health Evaluation version II (APACHE II), Simplified Acute Physiology Score version II (SAPS II), Sepsis-related Organ Failure Assessment (SOFA) and Acute Tubular Necrosis Individual Severity Index (ATN-ISI) to predict in-hospital mortality of critically ill patients with AKI. A prospective observational study was conducted in a university teaching hospital. 189 consecutive critically ill patients with AKI were selected according Risk, Injury, Failure, Loss, or End-stage kidney disease criteria. APACHE II, SAPS II, SOFA and ATN-ISI counts were obtained within the first 24 hours following admission. Receiver operating characteristic analyses (ROCs) were applied. Area under the ROC curve (AUC) was calculated. Sensitivity and specificity of in-hospital mortality prediction were calculated. In this study, the in-hospital mortality of critically ill patients with AKI was 37.04% (70/189). AUC of APACHE II, SAPS II, SOFA and ATN-ISI was 0.903 (95% CI 0.856 to 0.950), 0.893 (95% CI 0.847 to 0.940), 0.908 (95% CI 0.866 to 0.950) and 0.889 (95% CI 0.841 to 0.937) and sensitivity was 90.76%, 89.92%, 90.76% and 89.08% and specificity was 77.14%, 70.00%, 71.43% and 71.43%, respectively. In this study, it was found APACHE II, SAPS II, SOFA and ATN-ISI are reliable in-hospital mortality predictors of critically ill patients with AKI. Trial registration number: NCT00953992.

  • Acute kidney injury (AKI)
  • acute tubular necrosis individual severity index (ATN-ISI)
  • mortality
  • Sepsis-related Organ Failure Assessment (SOFA)
  • severity score system

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  • Contributors All authors equally contributed to the conception and design of the research; YuG contributed to the design of the research; FD contributed to the acquisition and analysis of the data; YuG and FZ contributed to the analysis of the data; YoG contributed to the acquisition, analysis and interpretation of the data. All authors drafted the manuscript, critically revised the manuscript, agree to be fully accountable for ensuring the integrity and accuracy of the work and read and approved the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Ethics approval The protocol for this research project has been approved by the Ethics Committee of Huashan Hospital, Fudan University and the approval number is 2009-206.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Not required.

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