Skip to main content
Annals of Surgery logoLink to Annals of Surgery
. 1984 Aug;200(2):205–211. doi: 10.1097/00000658-198408000-00015

Probability of surviving postoperative acute renal failure. Development of a prognostic index.

W G Cioffi, T Ashikaga, R L Gamelli
PMCID: PMC1250446  PMID: 6465976

Abstract

Sixty-five patients who developed postoperative acute renal failure requiring hemodialysis were retrospectively analyzed to identify variables that could be used to predict outcome. Our aim was to identify patients who would have an unfavorable outcome despite hemodialysis and to identify those factors that might be altered to improve outcome. A linear discriminant function capable of segregating survivors from nonsurvivors in the retrospective analysis was subsequently validated in a prospective fashion using a second patient population. Variables used were age, sex, number of transfusions, interval from onset of acute renal failure to dialysis, type of surgery, preoperative hypotension, and the presence of cardiac failure. Scores were formulated for each patient and then segregated into three groups: patients with no precedence for survival, patients with an intermediate risk of dying, and patients with low risk of dying. Based on the univariant analysis, the interval from onset of acute renal failure to first dialysis and the maximum serum creatinine prior to first dialysis were the only factors that might be altered to change mortality. The prognostic index we have developed enables one to select patients without a chance of survival.

Full text

PDF

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Abel R. M., Buckley M. J., Austen W. G., Barnett G. O., Beck C. H., Jr, Fischer J. E. Etiology, incidence, and prognosis of renal failure following cardiac operations. Results of a prospective analysis of 500 consecutive patients. J Thorac Cardiovasc Surg. 1976 Mar;71(3):323–333. [PubMed] [Google Scholar]
  2. Baek S. M., Makabali G. G., Shoemaker W. C. Clinical determinants of survival from postoperative renal failure. Surg Gynecol Obstet. 1975 May;140(5):685–689. [PubMed] [Google Scholar]
  3. Baker S. P., O'Neill B., Haddon W., Jr, Long W. B. The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma. 1974 Mar;14(3):187–196. [PubMed] [Google Scholar]
  4. Baue A. E. Multiple, progressive, or sequential systems failure. A syndrome of the 1970s. Arch Surg. 1975 Jul;110(7):779–781. doi: 10.1001/archsurg.1975.01360130011001. [DOI] [PubMed] [Google Scholar]
  5. Bhat J. G., Gluck M. C., Lowenstein J., Baldwin D. S. Renal failure after open heart surgery. Ann Intern Med. 1976 Jun;84(6):677–682. doi: 10.7326/0003-4819-84-6-677. [DOI] [PubMed] [Google Scholar]
  6. Butkus D. E. Persistent high mortality in acute renal failure. Are we asking the right questions? Arch Intern Med. 1983 Feb;143(2):209–212. [PubMed] [Google Scholar]
  7. Casali R., Simmons R. L., Najarian J. S., von Haritizsch B., Buselmeier T. J., Kjellstrand C. M. Acute renal insufficiency complicating major cardiovascular surgery. Ann Surg. 1975 Mar;181(3):370–375. doi: 10.1097/00000658-197503000-00020. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Chawla S. K., Najafi H., Ing T. S., Dye W. S., Javid H., Hunter J. A., Goldin M. D., Serry C. Acute renal failure complicating ruptured abdominal aortic aneurysm. Arch Surg. 1975 May;110(5):521–526. doi: 10.1001/archsurg.1975.01360110067012. [DOI] [PubMed] [Google Scholar]
  9. Conger J. D. A controlled evaluation of prophylactic dialysis in post-traumatic acute renal failure. J Trauma. 1975 Dec;15(12):1056–1063. doi: 10.1097/00005373-197512000-00003. [DOI] [PubMed] [Google Scholar]
  10. Drucker W. R., Gavett J. W., Kirshner R., Messick W. J., Ingersoll G. Toward strategies for cost containment in surgical patients. Ann Surg. 1983 Sep;198(3):284–300. doi: 10.1097/00000658-198309000-00005. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Eiseman B., Beart R., Norton L. Multiple organ failure. Surg Gynecol Obstet. 1977 Mar;144(3):323–326. [PubMed] [Google Scholar]
  12. Eiseman B., Sloan R., Hansbrough J., McIntosh R. Multiple organ failure: clinical and experimental. Am Surg. 1980 Jan;46(1):14–19. [PubMed] [Google Scholar]
  13. Fulton R. L., Jones C. E. The cause of post-traumatic pulmonary insufficiency in man. Surg Gynecol Obstet. 1975 Feb;140(2):179–186. [PubMed] [Google Scholar]
  14. Gailiunas P., Jr, Chawla R., Lazarus J. M., Cohn L., Sanders J., Merrill J. P. Acute renal failure following cardiac operations. J Thorac Cardiovasc Surg. 1980 Feb;79(2):241–243. [PubMed] [Google Scholar]
  15. Gordon D., Calne R. Y. Renal failure in acute pancreatitis. Br Med J. 1972 Sep 30;3(5830):801–802. doi: 10.1136/bmj.3.5830.801. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Iaina A., Reisin E., Eliahou H. Acute renal failure in combat injuries. J Trauma. 1975 Apr;15(4):281–284. doi: 10.1097/00005373-197504000-00003. [DOI] [PubMed] [Google Scholar]
  17. Ireland G. W., Cass A. S. Post-traumatic acute renal failure. J Urol. 1974 Apr;111(4):425–428. doi: 10.1016/s0022-5347(17)59982-6. [DOI] [PubMed] [Google Scholar]
  18. Karátson A., Juhász J., Hübler J., Szalmásy Z., Frang D. Factors influencing the prognosis of acute renal failure. (Analysis of 228 cases). Int Urol Nephrol. 1978;10(4):321–333. doi: 10.1007/BF02082372. [DOI] [PubMed] [Google Scholar]
  19. Kwaan J. H., Connolly J. E. Renal failure complicating aortoiliofemoral reconstructive procedure. Am Surg. 1980 May;46(5):295–297. [PubMed] [Google Scholar]
  20. Luft F. C., Hamburger R. J., Dyer J. K., Szwed J. J., Kleit S. A. Acute renal failure following operation for aortic aneurysm. Surg Gynecol Obstet. 1975 Sep;141(3):374–378. [PubMed] [Google Scholar]
  21. Matas A. J., Payne W. D., Simmons R. L., Buselmeier T. J., Kjellstrand C. M. Acute renal failure following blunt civilian trauma. Ann Surg. 1977 Mar;185(3):301–306. doi: 10.1097/00000658-197703000-00009. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. McCombs P. R., Roberts B. Acute renal failure following resection of abdominal aortic aneurysm. Surg Gynecol Obstet. 1979 Feb;148(2):175–178. [PubMed] [Google Scholar]
  23. McLeish K. R., Luft F. C., Kleit S. A. Factors affecting prognosis in acute renal failure following cardiac operations. Surg Gynecol Obstet. 1977 Jul;145(1):28–32. [PubMed] [Google Scholar]
  24. Porter J. M., McGregor F., Jr, Acinapura A. J., Silver D. Renal function following abdominal aortic aneurysmectomy. Surg Gynecol Obstet. 1966 Oct;123(4):819–825. [PubMed] [Google Scholar]
  25. Ray J. F., 3rd, Winemiller R. H., Parker J. P., Myers W. O., Wenzel F. J., Sautter R. D. Proceedings: Postoperative renal failure in the 1970s: a continuing challenge. Arch Surg. 1974 Apr;108(4):576–583. doi: 10.1001/archsurg.1974.01350280176029. [DOI] [PubMed] [Google Scholar]
  26. Routh G. S., Briggs J. D., Mone J. G., Ledingham I. M. Survial from acute renal failure with and without multiple organ dysfunction. Postgrad Med J. 1980 Apr;56(654):244–247. doi: 10.1136/pgmj.56.654.244. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Tilney N. L., Bailey G. L., Morgan A. P. Sequential system failure after rupture of abdominal aortic aneurysms: an unsolved problem in postoperative care. Ann Surg. 1973 Aug;178(2):117–122. doi: 10.1097/00000658-197308000-00001. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from Annals of Surgery are provided here courtesy of Lippincott, Williams, and Wilkins

RESOURCES