Easy and Early Prognosis in Acute Tubular Necrosis: A Forward Analysis of 228 Cases

Liaño, Fernando; Garcia-Martin, F.; Gallego, A.; Orte, L; Jl, Teruel; Marcén, R.; Matesanz, Rafael; Ortuño, J

doi:10.1159/000185314

Cited by 96 publications

(55 citation statements)

References 11 publications

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“…Then, we, as Smithies and Cameron [8] pointed out that our observations might be confirmed by applying them to control groups [7], The aims of the present extended prospective work were: (1) to establish early indi vidual prognosis of patients with ATN applying prelimi nary results to a control population in our service and in another group of patients from another hospital; (2) to identify, if possible, groups of patients without changes for survival, and (3) to compare accuracy and usefulness of linear and logistic multiple regression models. Our investi gations indicate that an easy and early prognosis of ATN can be given using simple clinical features, and a discrimi nant score allows to distinguish the patients without chan ces for survival.…”

Section: Introductionmentioning

confidence: 53%

“…In a previous work [7], we reported the first study in which, using a multiple regression analysis of clinical data obtained at referral to the nephrologist, we were able to derive relative weight for relevant risk factors so that a probability of death after acute tubular necrosis (ATN) could be predicted. Then, we, as Smithies and Cameron [8] pointed out that our observations might be confirmed by applying them to control groups [7], The aims of the present extended prospective work were: (1) to establish early indi vidual prognosis of patients with ATN applying prelimi nary results to a control population in our service and in another group of patients from another hospital; (2) to identify, if possible, groups of patients without changes for survival, and (3) to compare accuracy and usefulness of linear and logistic multiple regression models.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Prognosis of Acute Tubular Necrosis: An Extended Prospectively Contrasted Study

Liaño

Gallego²,

Pascual³

et al. 1993

Nephron

197

128

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The ability to predict the outcome in acute tubular necrosis (ATN) remains elusive despite considerable efforts. Accurate prediction is a crucial priority and has large economical and ethical implications, mainly to judge when treatment is futile and further efforts only prolong miserable agony. To analyze the influence of risk factors in the prognosis of ATN, we applied, in an initial phase, a prospective protocol of demographic data, cause of renal failure, diuresis, need of dialysis and clinical conditions in 228 patients using multiple linear and logistic regression models. In a control phase with 100 consecutive patients, we checked the accuracy of the results previously obtained, evaluating further the overall population of 328 patients in a synthetic phase. Finally, the validation of the equations obtained was verified in 25 patients from another hospital. As a complement of this 4-phase study, detailed statistical comparisons between both linear and logistic multiple regression models were undertaken. Correlation between probability of death obtained with equations from the initial phase applied to control patients and real evolution of these patients, survival or death, was excellent. The study of the synthetic phase revealed coma, assisted respiration, hypotension, oliguria and jaundice as having an independent positive influence on mortality and nephrotoxic etiology and normal consciousness on good prognosis. For the linear model, the same cut-off point of discriminant score (0.9) above which there were no chances for survival could be established in the 4 phases. With the logistic model, it only was found at later phases. The multiple linear was better than the logistic regression model in terms of better correlation with real mortality, better sensitivity and specificity intervals, easier use of discriminant cut-off point and better adjustment of distribution of standardized residuals to expected normal function. Early prognosis of ATN is possible and can be given using simple clinical features. A discriminant score allows to distinguish patients without chances for survival. The multiple linear is better than the logistic regression model in the prediction of the outcome in ATN.

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Section: Introductionmentioning

confidence: 53%

Section: Introductionmentioning

confidence: 99%

Prognosis of Acute Tubular Necrosis: An Extended Prospectively Contrasted Study

Liaño

Gallego²,

Pascual³

et al. 1993

Nephron

197

128

View full text Add to dashboard Cite

show abstract

“…The development of acute renal failure increases morbidity (31,32), cost (33), and mortality (34 -37). Exposure to radiocontrast media is a common iatrogenic cause of acute renal failure among hospitalized patients with chronic kidney disease (38).…”

Section: Discussionmentioning

confidence: 99%

N-Acetylcysteine for the Prevention of Radiocontrast Induced Nephropathy

Kshirsagar¹,

Poole²,

Mottl³

et al. 2004

Journal of the American Society of Nephrology

210

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Abstract. N-acetylcysteine has been recommended for patients with renal insufficiency who are to receive radiocontrast media. However, trials of oral N-acetylcysteine for the prevention of radiocontrast-induced nephropathy have yielded inconsistent results. A systematic review of patient and study characteristics was undertaken to discover possible explanations of the inconsistencies. The databases MEDLINE, EMBASE, and CENTRAL (1966 to March 2003) were searched in all languages, and conference proceedings from several professional societies from the years 1999 to 2003 were also searched. Only prospective controlled trials of oral N-acetylcysteine were included. Risk difference estimates and 95% confidence intervals were calculated. The estimates were examined for evidence of publication bias and heterogeneity. Stratified and meta-regression analyses were used to compare estimates by study and patient characteristics. Identified were 16 studies, 15 published and 1 unpublished. There was no evidence of publication bias, but there was substantial evidence of heterogeneity, thus precluding reliance on a meaningful summary effect estimate. Meta-regression identified several patient and study characteristics, with some evidence of association with study-specific estimates. None of these characteristics, however, formed subsets of studies with results that were homogeneous enough to aggregate. Research on N-acetylcysteine and the incidence of radiocontrast nephropathy is too inconsistent at present to warrant a conclusion on efficacy or a recommendation for its routine use. Identified patient and study characteristics may be responsible for some, but not all, of this inconsistency. A large, randomized, placebo-controlled trial, a pooled analysis of patient-level data, or both may resolve this issue.Over the last 3 yr, enthusiasm for the use of oral N-acetylcysteine to prevent radiocontrast-induced nephropathy has been growing (1). A breakthrough study (2) first reported a large and significant reduction in the risk of radiocontrast-induced nephropathy compared with placebo among patients with moderate renal dysfunction. Subsequent studies produced mixed results (3-6). Recently, a large study (7), arguably with a relatively high degree of power and sound methods, seemed to confirm the beneficial effect of this agent. N-acetylcysteine is now being routinely recommended as preventative therapy, as an additive to low-osmolar contrast media and intravenous hydration, for patients with reduced renal function who are to undergo a planned exposure to radiocontrast media (8,9). Yet the reasons for discrepant findings among the trials need investigation before the widespread use of N-acetylcysteine can be recommended.We therefore performed a systematic review and metaanalysis of available prospective controlled trials to quantify and compare reported associations of oral N-acetylcysteine with the incidence of nephropathy after exposure to radiocontrast media. For this review, we examined several key questions. Is there evidenc...

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“…Liaño et al 35 , em 1989, desenvolveram um estudo que utiliza a análise de regressão múltipla de dados clínicos obtidos, pela primeira vez, por nefrologista, sendo capaz de verificar pesos relativos para fatores de risco relevantes para a probabilidade de morte após NTA.…”

Section: Discussionunclassified

Mortalidade e prognóstico específico em pacientes com insuficiência renal aguda

Balbi

Ponce²,

Barsante³

et al. 2005

Rev. Assoc. Med. Bras.

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RESUMO 16,17 vêm sendo utilizados, em UTI, para predizer o desfecho de um determinado grupo de pacientes com patologias graves, dentre elas a IRA. D'Ávila et al. 18 mostraram que o APACHE II, utilizado isoladamente, foi pouco adequado como preditor de IRA em pacientes internados em UTI, pois foi sensível para prever não sobrevivente, mas pouco específico. Fery-Lemonnier-E et al. 19 , relacionand o índices prognósticos em IRA, incluindo o APACHE II e SAPS e número de falências de órgãos, concluíram que há em todos eles fontes de ambigüidades nas orientações que devem ser usadas para sua coleta e que a variação entre o valor do índice dado a um paciente por um observador diferia do outro numa magnitude tal que poderia introduzir alterações nos estudos que os utilizassem.Na busca de novos índices prognósticos específicos para pacientes que desenvolvem IRA, Liãno et al. 20 propuseram um escore que pode ser usado também para pacientes internados fora de UTI, denominado escore de severidade individual de necrose tubular aguda (ATN-ISS), obtido imediatamente após a hospitalização ou no momento do atendimento do nefrologista, o que ocorre geralmente até 48 horas após a internação. Este índice foi testado pelo próprio autor em 100 pacientes e, quando comparado com o APACHE II, mostrou excelente confiabilidade. Diversos trabalhos posteriores utilizaram o escore ATN-ISS para pacientes com IRA em situações clínicas diferentes, destacando-se os trabalhos de Douma et al. 5 , Metha et al. 21 e, no Brasil, Fernandes et al. 22 , Cendoroglo et al. 23 e Teixeira et al. 24 . Nós também utilizamos o escore ATN-ISS para randomizar grupos de pacientes com IRA e avaliar métodos de diálise e permanência em UTI, com bons resultados 25,26 .

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Easy and Early Prognosis in Acute Tubular Necrosis: A Forward Analysis of 228 Cases

Cited by 96 publications

References 11 publications

Prognosis of Acute Tubular Necrosis: An Extended Prospectively Contrasted Study

Prognosis of Acute Tubular Necrosis: An Extended Prospectively Contrasted Study

N-Acetylcysteine for the Prevention of Radiocontrast Induced Nephropathy

Mortalidade e prognóstico específico em pacientes com insuficiência renal aguda

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