NDT Advance Access originally published online on July 20, 2004
Nephrology Dialysis Transplantation 2004 19(9):2282-2288; doi:10.1093/ndt/gfh364
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Nephrol Dial Transplant Vol. 19 No. 9 © ERA-EDTA 2004; all rights reserved
Original Article
Re-evaluation and modification of the Stuivenberg Hospital Acute Renal Failure (SHARF) scoring system for the prognosis of acute renal failure: an independent multicentre, prospective study
1 Department of Nephrology-Hypertension, ACZA Campus Stuivenberg, Lange Beeldekensstraat 267, B-2060 Antwerpen, 2 Department of Nephrology-Hypertension, University Hospital Antwerp, Wilrijkstraat 10, B-2650 Edegem/Antwerpen, 3 Department of Nephrology-Hypertension, Sint Jozefziekenhuis, Steenweg op Merksplas 44, B-2300 Turnhout, 4 Department of Nephrology-Hypertension, O.L.-Vrouw Ziekenhuis, Moorselbaan 164, B-9300 Aalst, 5 Department of Intensive Care, General Hospital Middelheim, Lindendreef 1, B-2020 Antwerpen and 6 Department of Nephrology-Hypertension, Free University Brussels (VUB), Laarbeeklaan 101, B-1090 Brussels, Belgium
Correspondence and offprint requests to: Robert Lins, MD, PhD, Department of Nephrology-Hypertension, ACZA Campus Stuivenberg, Lange Beeldekensstraat 267, B-2060 Antwerpen, Belgium. Email: robert.lins{at}pro.tiscali.be
Background. A prognostic scoring system for hospital mortality in acute renal failure (Stuivenberg Hospital Acute Renal Failure, SHARF score) was developed in a single-centre study. The scoring system consists of two scores, for the time of diagnosis of acute renal failure (ARF) and for 48 h later, each originally based on four parameters (age, serum albumin, prothrombin time and heart failure). The scoring system was now tested and adapted in a prospective study.
Methods. The study involved eight intensive care units. We studied 293 consecutive patients with ARF in 6 months. Their mortality was 50.5%. The causes of ARF were medical in 184 (63%) patients and surgical in 108 (37%). In the latter group, 74 (69%) patients underwent cardiac and 19 (18%) vascular surgery.
Results. As the performance of the original SHARF scores was much lower in the multicentre study than in the original single-centre study, we re-analysed the multicentre data to customize the original model for the population studied. The independent variables were the score developed in the original study plus all additonal parameters that were significant on univariate analysis. The new multivariate analysis revealed an additional subset of three parameters for inclusion in the model (serum bilirubin, sepsis and hypotension). For the modified SHARF II score, r2 was 0.27 at 0 and 0.33 at 48 h, respectively, the receiver operating characteristic (ROC) values were 0.82 and 0.83, and the Hosmer–Lemeshow goodness-of-fit P values were 0.19 and 0.05.
Conclusion. After customizing and by using two scoring moments, this prediction model for hospital mortality in ARF is useful in different settings for comparing groups of patients and centres, quality assessment and clinical trials. We do not recommend its use for individual patient prognosis.
Keywords: acute renal failure; intensive care unit; mortality prediction; prognosis; prospective multicentre study; severity score
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