• Paulo Benigno Pena Batista, Miguel Cendorogolo Neto, Oscar Fernando Pavão dos Santos, Ana Clarissa Carvalho Bacelar, Gervásio Batista Campos, and Elise Schaer Carvalho dos Santos.
• Nephrology and Hemodialysis Service, São Rafael Hospital, Salvador, Bahia, Brazil. pbenigno@terra.com.br
• Ren Fail. 2004 Sep 1; 26 (5): 545-52.

ObjectiveTo study different prognostic indexes in acute renal failure (ARF) patients admitted to an intensive care unit (ICU).DesignProspective, cohort study. Individual Severity Score-Acute Tubular Necrosis (ISS-ATN) obtained prospectively and retrospectively, Acute Physiologic and Chronic Health Evaluation (APACHE II) Score, APACHE II Risk, Lung Injury Score (LIS), and Number of Organ Failures (NOF) were calculated for each patient. The outcome analyzed was death in the ICU. Discrimination was evaluated by the area under the receiver operator characteristic curve (AUC). For calibration analysis, the chi-square goodness-of-fit test was used to compare predicted mortality, calculated by ISS-ATN (obtained prospectively or retrospectively) and APACHE II risk, with observed mortality.SettingICU, São Rafael Hospital, Salvador-BA, Brazil.PatientsSeventy-six ARF patients admitted to the ICU within 6 months.InterventionsSurgical and medical procedures.Measurements And ResultsThe observed AUC was 0.69 for LIS, 0.73 for prospective ISS-ATN, 0.75 for retrospective ISS-ATN, 0.76 for APACHE II Score, 0.78 for APACHE II Risk, and 0.88 for NOF. These areas were significantly different from 0.5 (p < .001). There was no difference between the observed and expected death rate calculated by ISS-ATN. However, APACHE II underestimated the observed mortality (p < .001).ConclusionThe prognostic indexes studied showed good discriminative power. However, APACHE II was not well calibrated in contrast to the good calibration of ISS-ATN.

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