The impact of Karnofsky performance scale

Published Date: 10th August 2016

Publication Authors: Tridente A

​

Introductions

Karnofsky performance scale (KPS) [1] is being widely to describe patients’ functional status. Correlation between poor functional levels and adverse outcomes has been found. KPS is used in decision making surrounding starting aggressive therapy. We evaluated the impact of KPS on long term renal & patient survival in AKI patients, receiving renal replacement therapy (RRT) in intensive care (ICU).

Methods

We prospectively enrolled AKI ICU patients between October 2011 & October 2013. Demographics, APACHE II and SOFA scores, modality & dose of RRT, ICU length of stay (LOS) and KPS were collected. Data on renal and patient survival at ICU discharge, at 28 and 90 days and also 12 months were collected. Analysis used was multivariate logistic regression (Stata 14.1).

Results

155 patients were recruited. 97 (62.6 %) were males. Median age was 62 (IQR 47-72). Median APACHE II score was 23 (IQR 18-27). Median SOFA score on admission was 10 (IQR 7-13). 101 (66 %) were mechanically ventilated, median LOS was 6.8 (IQR 2.7-14.9) days, median KPS was 80 (IQR 70-90), 79 (51 %) patients were dependent on RRT at ICU discharge, with 61 (39.4 %), 56 (36.1 %) and 56 (36.1 %) at 28 & 90 days and 12 months respectively. 105 (66.7 %) patients survived to ICU discharge, with 94 (61.4 %), 88 (57.5 %) and 80 (52.3 %) patients being alive at 28 & 90 days and 12 months respectively. Adjusting for age and sex, APACHE II was the only factor associated with patient need for RRT at ICU discharge, 28 days, 90 days and 12 months (OR 1.09, 95 % CI: 1.03-1.15, p = 0.003; OR 1.1, 95%CI 1.04-1.16, p = 0.001; OR 1.1, 95%CI 1.04-1.17, p = 0.001 and OR 1.1, 95%CI 1.04-1.17, p = 0.001, respectively). After adjusting for age and sex, admission SOFA (OR 0.88, 95%CI 0.8-0.97, p = 0.008), APACHE II (OR 0.89, 95%CI 0.84-0.95, <0.001) and KPS (OR 1.03, 95%CI 1-1.06, p = 0.049) were associated with ICU survival.  However at multivariate regression analysis, only APACHE II was independently associated with ICU survival (OR 0.91, 95%CI 0.85-0.97, p = 0.003).

Conclusions

Disease severity remains the main determinant of outcome in AKI patients receiving RRT on ICU. Despite the apparent relevance of KPS to outcomes on critical care, we could not in this instance show that KPS independently affected renal or patient survival. More studies on larger numbers of patients are required to clarify this issue.

Elsayed, I; Ward, N; Tridente, A; Raithatha, A. (2016). The impact of Karnofsky performance scale on outcomes in acute kidney injury patients receiving renal replacement therapy on the intensive care unit​ . Critical Care. 20 (Suppl 2), 78.

« Back