In this episode, I’ll discuss an alternative scoring system for predicting the risk of augmented renal clearance.
Augmented renal clearance is a phenomenon in some critically ill patients whereby their kidney function becomes supranormal. Standard antibiotic doses are often inadequate in the setting of ARC.
The most accurate scoring system to identify patients at risk for ARC is the ARC Score. This score has a positive predictive value of 75% and a negative predictive value of 100%. Patients get 6 points if they are 50 years or younger, 3 points if they are admitted for trauma, and 1 point if their SOFA score is 4 or less upon ICU admission. An ARC score >6 is associated with augmented renal clearance.
One criticism of this scoring system is that it is cumbersome and not realistic because it requires the separate calculation of the SOFA score. An alternative scoring system, the ARCTIC score has almost as good results as the ARC score for predicting augmented renal clearance.
The ARCTIC scoring system is: 4 points if age is younger than 56 years, 3 points if age is 56 years to 75 years, 3 points if SCr less than 0.7 mg/dL, and 2 points if male sex. Again, a positive score is 6 or higher. The negative predictive value is 84% and the positive predictive value is 68%. Both values are slightly less than the ARC score but the calculation is much easier to complete.
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It appears the trial for the ARCTIC scoring system was done exclusively on Trauma ICU patients. Considering trauma alone increases the risk of ARC, do you believe this would be an accurate tool to use in a general ICU population? The removal of the SOFA score is appealing from a time constraint stand point if the tool is applicable.