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Published on: January 16, 2019
Systematic Review and Meta-Analysis of Intensive Care Unit Scoring Systems' Performance in Patients with Pre-Existing
Hajar El-Wadia1,2, Marisha Karim2, Amos Buh2
1School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada.
Kidney International Reports
|June 4, 2026
Summary
Intensive care unit (ICU) scoring systems often overestimate mortality risk in patients with end-stage kidney disease (ESKD) on dialysis and kidney transplant recipients (KTRs). Recalibration is needed for these patient groups.
Area of Science:
- Nephrology
- Critical Care Medicine
- Biostatistics
Background:
- Intensive care unit (ICU) scoring systems are vital for prognosticating mortality.
- Existing systems often do not incorporate baseline kidney function.
- Patients with chronic kidney disease (CKD), end-stage kidney disease (ESKD), and kidney transplant recipients (KTRs) represent unique populations.
Purpose of the Study:
- To systematically review and meta-analyze the prognostic performance of common ICU scoring systems.
- To evaluate these systems in patients with nondialysis CKD, ESKD on maintenance dialysis, and KTRs.
- To assess discrimination and calibration of ICU scores in these specific kidney disease populations.
Main Methods:
- Systematic literature search of Ovid Medline, Embase, and Scopus up to October 10, 2024.
- Inclusion of observational studies reporting prognostic performance of ICU scoring systems for mortality.
- Analysis of data from 12 studies involving 578,027 patients.
Main Results:
- Five ICU scoring systems (SOFA, APACHE II/III, SAPS II/III) were evaluated.
- Excellent discrimination was observed for ESKD patients on dialysis, but with lower performance than the general ICU population.
- Consistent overestimation of mortality risk in ESKD and poor discrimination in KTRs were noted.
Conclusions:
- Current ICU scoring systems frequently overestimate mortality risk in ESKD patients on dialysis and KTRs.
- There is a critical need for the development or recalibration of ICU scoring systems tailored to patients with pre-existing kidney disease.
- Findings underscore the limitations of general scoring systems in specialized patient cohorts.
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