Cardiorenal Syndrome Diagnosis Score - Medical Algorithm

The cardiorenal syndrome involves a combination of cardiac and renal failure, resulting in decompensation of the circulatory system.

Features of the cardiorenal syndrome:

(1) initial presence with heart or renal failure

(2) decompensation in the other organ's function

The typical patient is hospitalized for heart failure and then is found to be resistant to diuretics.

Patients at risk (Boerrigter and Burnett):

(1) history of heart failure

(2) history of diabetes mellitus

(3) serum creatinine on admission >= 1.5 mg/dL

(4) systolic blood pressure on admission > 160 mm Hg

(5) therapy with calcium channel blockers

(6) requirement for a higher dose of loop diuretic

where:

• A lower serum creatinine threshhold may be appropriate in an older patient.

Forman et al developed a score based on the following point assignment:

Parameter	Finding	Points
history of previous episodes of CHF	none	0
	present	1
history of diabetes mellitus	none	0
	present	1
systolic blood pressure	<= 160 mm Hg	0
	> 160 mm Hg	1
serum creatinine	< 1.5 mg/dL	0
	1.5 - 2.49 mg/dL	2
	>= 2.5 mg/dL	3

total score =

= SUM(points for all 4 parameters)

Interpretation:

• minimum score: 0

• maximum score: 6

• The higher the score the greater the risk of worsening renal function.

Total Score	Probability of Worsening Renal Function
0	10%
1	19%
2	20%
3	30%
4 - 6	53%

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Criteria for the Diagnosis of the Cardiorenal Syndrome and the Score of Forman et al for Predicting Worsening Renal Function in a Patient Hospitalized with Heart Failure