RESUMO
BACKGROUND: A recent prognostic model, predicting 60-day case fatality in critically ill patients requiring renal replacement therapy (RRT), has been developed (Acute Renal Failure Trial Network [ATN] study). Because many prognostic models are suggested in literature, but just a few have found its way into clinical practice, we aimed to externally validate this prediction model in an independent cohort. METHODS: A total of 1,053 critically ill patients requiring RRT from the MIMIC-III database were analyzed. The models' discrimination was evaluated using c-statistics. Calibration was evaluated by Hosmer-Lemeshow (H-L) test and GiViTi calibration belt. RESULTS: In a case-mix population, including patients with normal or altered serum creatinine (sCr) at intensive care unit admission, discrimination was moderate, with a c-statistic of 0.71 in the nonintegerized risk model. In patients with altered baseline sCr, better discrimination was achieved with the integer risk model (0.76, 95% confidence interval, 0.71-0.81). As for the calibration, although the H-L test was good only in patients with normal/slightly altered sCr at admission, the calibration belt disclosed no significant deviations from the bisector line for any of the models in patients, regardless of admission sCr. Of note, a refitted model had a c-statistics of 0.85, similar to the derivation cohort. CONCLUSIONS: The ATN prognostic model can be useful in a broad cohort of critically ill patients. Although it showed only moderate discrimination capacity when patients with elevated admission sCr were included, using a refitted model improved it, illustrating the need for continuous external validation and updating of prognostic models over time before their implementation in clinical practice.
Assuntos
Injúria Renal Aguda , Creatinina/sangue , Bases de Dados Factuais , Modelos Biológicos , Terapia de Substituição Renal , Injúria Renal Aguda/sangue , Injúria Renal Aguda/diagnóstico , Injúria Renal Aguda/terapia , Idoso , Estado Terminal , Feminino , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Medição de RiscoRESUMO
O objetivo foi avaliar a produção científica na enfermagem brasileira sobre nefrologia nas teses e dissertações publicadas de 2001 a 2007. Foi realizado um estudo bibliométrico apartir dos teses e dissertações de enfermagem catalogadas no Centro de Estudos e Pesquisas em Enfermagem. Detectou-se 50 trabalhos sobre nefrologia, predominando: 45 (90 por cento) dissertações; 30 (60 por cento) no estado de São Paulo; 18 (36 por cento) em clínicas de diálise; 39 (78 por cento) sujeitos foram pacientes. Quanto aos tipos de estudos predominaram: 26 (52 por cento) exploratórios, 28 (56 por cento) levantamento e 27 (54 por cento) quantitativos. De acordo com o tema, a hemodiálise teve maior destaque, com 21 (42 por cento) publicações. As pesquisas científicas voltadas para essa temática possibilitam uma assistência multi e interdisciplinar, de forma individualizada, sistematizada e humanizada a essa clientela.
The purpose was to evaluate the scientific production in Brazilian nursing about nephrology in theses and dissertations published from 2001 to 2007. A bibliometric study was carried out with the nursing tesis and dissertations according to the Center of Studies and Researches in Nursing catalog. It was found 50 works on nephrology, predominating: 45 (90 percent) dissertations; 30 (60 percent) in the state of São Paulo; 18 (36 percent) in clinics of dialysis; 39 (78 percent) samples were patients. Considering the types of study, it predominated: 26 (52 percent) exploratory, 28 (56 percent) survey and 27 (54 percent) quantitative. Concerning the theme, hemodialysis predominated with 21 (42 percent) publications. Scientific researches on this theme make possible a multi and interdisciplinary assistance to these clients, in an individualized, systematized and humanized way.
El objetivo fue evaluar la producción científica en la enfermería brasileña sobre nefrología en las tesis y disertaciones publicadas de 2001 a 2007. Es un estudio bibliometrico, realizado con las tesis y desertaciones de enfermería catalogadas en el Centro de Estudios e Investigaciones en Enfermería. Se detectaron 50 trabajos sobre de nefrología, predominando: 45 (90 por ciento) disertaciones; 30 (60 por ciento) en el Estado de São Paulo; 18 (36 por ciento) en clínicas de diálisis; 39 (78 por ciento) la muestra fueron los pacientes. Los tipos de estudios predominaron: 26 (52 por ciento) exploratorios, 28 (56 por ciento) levantamiento y 27 (54 por ciento) cuantitativos. De acuerdo con el tema, la hemodiálisis tuvo mayor destaque, con 21 (42 por ciento) publicaciones. Las investigaciones científicas dirigidas a esta temática posibilitan una asistencia multi e inter-disciplinar, de forma individualizada, sistematizada y humanizada a estos pacientes.