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Nephrol Dial Transplant (2001) 16: 1098-1101
© 2001 European Renal Association-European Dialysis and Transplant Association

Editorial Comment

Problems in the development, validation and adaptation of prognostic models for acute renal failure

Robert L. Lins1,, Monique Elseviers2, Ronald Daelemans and Marc E. De Broe2

1 Department of Nephrology–Hypertension, A.C.Z.A. Campus Stuivenberg, Antwerp 2 Department of Nephrology–Hypertension, University Hospital Antwerp, Edegem/Antwerp, Belgium

Keywords: acute renal failure; disease management; prognostic models; scoring; treatment

Historical perspective of prognostic model development

Clinicians are frequently asked to make predictions concerning diagnosis, risk assessment or prognosis. In recent years, the science of prognostication (quantitative predictions) has evolved rapidly and critical care practice has been at the forefront of this important international trend [1]. Various scoring systems, mostly illness severity scores, have been developed to optimize the use of clinical experience in the intensive care unit (ICU) and to address questions of effectiveness, efficiency, quality of care and correct allocation of scarce resources [2]. Originally these scores were developed by the selection of variables and their perceived importance by experts on the basis of personal experience (Acute Physiology and Chronic Health Evaluation, APACHE system) [3]. Later, scores were based on multiple logistic regression of rather small databases (Mortality Probability Models, MPM I) [3]. After that, large databases were compiled prospectively from many ICUs (APACHE III, Simplified . . . [Full Text of this Article]

Single centre or multicentre development of scoring systems

Statistical problems in model design and testing

Performance and customization in subsets of patients and in other institutions

The use of scores in individual patients

Perspectives for the future

Conclusion

Notes

References


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