Acute kidney injury in intensive care unit patients: a comparison between the RIFLE and the Acute Kidney Injury Network classifications.
Acute kidney injury in intensive care unit patients: a comparison between the RIFLE and the Acute Kidney Injury Network classifications.
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DOI：
10.1186/cc6997
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发表时间：
2008
期刊：
影响因子：
--
通讯作者：
Prata MM
中科院分区：
文献类型：
--
作者：
Lopes JA;Fernandes P;Jorge S;Gonçalves S;Alvarez A;Costa e Silva Z;França C;Prata MM
目前尚不清楚急性肾损伤网络（AKIN）标准与风险、损伤、衰竭、肾功能丧失、终末期肾病（步枪）标准相比在灵敏度和特异性方面是否存在明显优势。我们评估了急性肾损伤的发生率，并比较了重症监护病房住院期间最大步枪和最大AKIN预测危重患者院内死亡率的能力。回顾性分析2003年1月至2006年12月期间我院重症医学科收治的患者。接受透析的慢性肾病患者或肾移植患者从分析中排除。共评价了662例患者（平均年龄：58.6 ± 19.2岁; 392例男性）。AKIN标准允许更多的患者被识别为急性肾损伤（50.4% vs 43.8%，P = 0.018），并将更多患者分类为1期（步枪中的风险）（21.1% vs 14.7%，P = 0.003），但第2阶段未观察到差异（步枪损伤）（10.1%与11%，P = 0.655）和第3阶段（步枪失败）（19.2%与18.1%，P = 0.672）。任何一种步枪标准定义的急性肾损伤的死亡率都明显较高（41.3%对11%，P < 0.0001;比值比= 2.78，95%置信区间= 1.74至4.45，P < 0.0001）或AKIN标准（39.8%对8.5%，P < 0.0001;比值比= 3.59，95%置信区间= 2.14至6.01，P < 0.0001）。步枪标准和AKIN标准的院内死亡率受试者工作特征曲线下面积分别为0.733和0.750（P < 0.0001）。急性肾损伤定义/分类标准的死亡率无统计学差异（P = 0.72）。虽然AKIN标准可以提高急性肾损伤诊断的敏感性，但似乎不能提高步枪标准预测危重患者住院死亡率的能力。
Whether discernible advantages in terms of sensitivity and specificity exist with Acute Kidney Injury Network (AKIN) criteria versus Risk, Injury, Failure, Loss of Kidney Function, End-stage Kidney Disease (RIFLE) criteria is currently unknown. We evaluated the incidence of acute kidney injury and compared the ability of the maximum RIFLE and of the maximum AKIN within intensive care unit hospitalization in predicting inhospital mortality of critically ill patients. Patients admitted to the Department of Intensive Medicine of our hospital between January 2003 and December 2006 were retrospectively evaluated. Chronic kidney disease patients undergoing dialysis or renal transplant patients were excluded from the analysis. In total, 662 patients (mean age, 58.6 ± 19.2 years; 392 males) were evaluated. AKIN criteria allowed the identification of more patients as having acute kidney injury (50.4% versus 43.8%, P = 0.018) and classified more patients with Stage 1 (risk in RIFLE) (21.1% versus 14.7%, P = 0.003), but no differences were observed for Stage 2 (injury in RIFLE) (10.1% versus 11%, P = 0.655) and for Stage 3 (failure in RIFLE) (19.2% versus 18.1%, P = 0.672). Mortality was significantly higher for acute kidney injury defined by any of the RIFLE criteria (41.3% versus 11%, P < 0.0001; odds ratio = 2.78, 95% confidence interval = 1.74 to 4.45, P < 0.0001) or of the AKIN criteria (39.8% versus 8.5%, P < 0.0001; odds ratio = 3.59, 95% confidence interval = 2.14 to 6.01, P < 0.0001). The area under the receiver operator characteristic curve for inhospital mortality was 0.733 for RIFLE criteria (P < 0.0001) and was 0.750 for AKIN criteria (P < 0.0001). There were no statistical differences in mortality by the acute kidney injury definition/classification criteria (P = 0.72). Although AKIN criteria could improve the sensitivity of the acute kidney injury diagnosis, it does not seem to improve on the ability of the RIFLE criteria in predicting inhospital mortality of critically ill patients.
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影响因子：
15.1
作者：
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8.8
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Hoste, Eric A. J.;Schurgers, Marie
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