The reevaluation of scoring systems for critical care during acute blood purification therapy

Abstract

During acute blood purification, it is very important to precisely estimate severity and prognosis in order to select the appropriate treatment and manage medical resources efficiently. In this paper we summarize a report in the Journal of Japanese Society for Dialysis Therapy (42(10): 761-767, 2009） on the usefulness of severity scores for these estimations1）. Initial investigation showed that cases with a sequential organ failure assessment (SOFA) score≦9 points, multiple organ dysfunction score (MODS)≦5 points, and life-saving index≦6 points survived. In contrast, cases with a SOFA score≧15 points, MODS≧14 points, and life-saving index≧10 points all died. We then re-investigated 5 of 14 cases of septic shock who underwent acute blood purification in the 14 month periods from April 2013 to May 2014. This showed 1 of 5 cases survived in spite of a pre-dialysis SOFA score of≧15 points and life-saving index≧10 points. This case had developed of septic shock immediately after surgical treatment for obstructive pyelonephritis, and was treated successfully by early goal directed fluid therapy (EGDT) and acute blood purification conforming to PMX-DHP, resulting in a rapid improvement in renal failure and survival of the patient. This case represents an examples of a patient who survived despite a high severity score. In order to further increase the prognostic accuracy of the severity scores, it is necessary to integrate such cases in future evaluations of these scores.