Figure 822

Ideally, prognosis should be established as the problem, the episode of acute renal failure (ARF), starts. Correct prognostic estimation gives the real outcome for a patient or group of patients as precisely as possible. In this ideal scenario, this fact is illustrated by giving the same surface area for the concepts of outcome and prognosis.

Mortality trends in acute renal failure (ARF). This figure shows the evolution of mortality during a 40-year period, starting in 1951. The graphic was elaborated after reviewing the outcome of 32,996 ARF patients reported in 258 published papers. As can be appreciated, mortality rate increases slowly but constantly during this follow-up, despite theoretically better availability of therapeutic armamentarium (mainly antibiotics and vasoactive drugs), deeper knowledge of dialysis techniques, and wider access to intensive care facilities. This improvement in supporting measures allows the physician to keep alive, for longer periods of time patients who otherwise would have died. A complementary explanation could be that the patients treated now are usually older, sicker, and more likely to be treated more aggressively. (From Kierdorf et al. [20]; with permission.)

Apache system

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