A multi-centre evaluation of the RIFLE criteria for early acute kidney injury in critically ill patients
A multi-centre evaluation of the RIFLE criteria for early acute kidney injury in critically ill patients
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DOI：
10.1093/ndt/gfm744
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发表时间：
2008-04-01
影响因子：
6.1
通讯作者：
Bellomo, Rinaldo
中科院分区：
文献类型：
--
作者：
Bagshaw, Sean M.;George, Carol;Bellomo, Rinaldo
背景。急性透析质量倡议工作组近期制定了RIFLE标准，这是急性肾损伤（AKI）的一个共识性定义。我们试图在一大群不同类型的重症患者进入重症监护病房（ICU）当天对RIFLE标准进行评估。
方法。对澳大利亚和新西兰重症监护学会成人患者数据库中前瞻性收集的数据进行回顾性调查。我们评估了2000年1月1日至2005年12月31日期间从澳大利亚57个ICU收治的住院时间≥24小时的120123名患者。
结果。年龄中位数（四分位间距）为64.3（50.8 - 75.4）岁，59.5%为男性，28.6%患有合并疾病，50.3%为内科收治患者，初始平均（±标准差）APACHE II评分为16.9（±7.7）。根据RIFLE标准，在入院当天，36.1%的患者发生AKI，其中RIFLE最高类别为风险（Risk）占16.3%，损伤（Injury）占13.6%，衰竭（Failure）占6.3%。由任何RIFLE类别定义的AKI都与医院死亡率增加相关（比值比3.29，95%置信区间3.19 - 3.41，P < 0.0001）。按RIFLE类别分层的粗医院死亡率为：风险类别17.9%，损伤类别27.7%，衰竭类别33.2%。通过多变量分析，每个RIFLE类别都与医院死亡率独立相关（比值比：风险1.58，损伤2.54，衰竭3.22）。
结论。在一大群不同类型的重症患者中，RIFLE标准在入院当天将超过36%的患者归类为AKI。随着RIFLE类别严重程度的依次增加，医院死亡率也相应增加。RIFLE标准是一种用于检测和分类AKI以及与临床结果相关联的简单工具。
Background. The Acute Dialysis Quality Initiative Working Group recently developed the RIFLE criteria, a consensus definition for acute kidney injury (AKI). We sought to evaluate the RIFLE criteria on the day of ICU admission in a large heterogenous population of critically ill patients.Methods. Retrospective interrogation of prospectively collected data from the Australian NewZealand Intensive Care Society Adult Patient Database. We evaluated 120 123 patients admitted for >= 24 h from 1 January 2000 to 31 December 2005 from 57 ICUs across Australia.Results. The median (IQR) age was 64.3 ( 50.8-75.4) years, 59.5% were male, 28.6% had co-morbid disease, 50.3% were medical admissions and the initial mean ( +/- SD) APACHEII score was 16.9 ( +/- 7.7). According to the RIFLE criteria, on the day of admission, AKI occurred in 36.1%, with a maximum RIFLE category of Risk in 16.3%, Injury in 13.6%, and Failure 6.3%. AKI, defined by any RIFLE category, was associated with an increase in hospital mortality ( OR 3.29, 95% CI 3.19-3.41, P 0.0001). The crude hospital mortality stratified by RIFLE category was 17.9% for Risk, 27.7% for Injury and 33.2% for Failure. By multi-variable analysis, each RIFLE category was independently associated with hospital mortality ( OR: Risk 1.58, Injury 2.54 and Failure 3.22).Conclusion. In a large heterogenous cohort of critically ill patients, the RIFLE criteria classified > 36% with AKI on the day of admission. For successive increases in severity of RIFLE category, there were increases in hospital mortality. The RIFLE criteria represent a simple tool for the detection and classification of AKI and for correlation with clinical outcomes.