RIFLE classification can predict short-term prognosis in critically ill cirrhotic patients
RIFLE classification can predict short-term prognosis in critically ill cirrhotic patients
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DOI：
10.1007/s00134-007-0760-6
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发表时间：
2007-11-01
影响因子：
38.9
通讯作者：
Yang, Chih-Wei
中科院分区：
文献类型：
--
作者：
Jenq, Chang-Chyi;Tsai, Ming-Hung;Yang, Chih-Wei
目的：终末期肝病常合并肾功能障碍。肝硬化合并肾衰竭的患者入住重症监护室（ICU）的死亡率很高。本研究分析了危重患者的预后，并确定了预后与步枪（肾衰竭风险、肾损伤、肾功能衰竭、肾功能丧失和终末期肾衰竭）分类之间的相关性，并与其他五种评分系统进行了比较。设计：前瞻性临床研究。设置：台湾一所大学医院的十床肝胃专科ICU。患者和参与者：在1.5年期间连续入住ICU的134例腹泻患者。干预措施：分析了32个人口统计学、临床和实验室变量作为生存预测因素。测量结果和主要结果：总体住院死亡率为65.7%。根据步枪分级严重程度，死亡率呈进行性显著增加（趋势卡方（2）：< 0.001）。多因素Logistic回归分析显示，步枪分级和入住ICU第1天的序贯器官衰竭评估（SOFA）评分是影响住院死亡率的独立危险因素。通过使用受试者工作特征曲线下面积（AUROC），步枪类别和SOFA均显示出良好的区分能力（AUROC 0.837 +/- 0.036和0.917 +/- 0.025; < 0.001）。6个月随访时，非ARF与RIFLE-R、RIFLE-I和RIFLE-F的累积生存率存在显著差异（< 0.05）。结论：SOFA和步枪分类在预测肝硬化危重患者住院死亡率方面具有较高的鉴别力。步枪分类是一种简单易行的评估工具，具有良好的预后能力。
Objective: End-stage liver disease is frequently complicated by renal function disturbances. Cirrhotic patients with renal failure admitted to intensive care units (ICUs) have high mortality rates. This study analyzed the outcomes of critically ill cirrhotic patients and identified the association between prognosis and RIFLE (risk of renal failure, injury to kidney, failure of kidney function, loss of kidney function, and end-stage renal failure) classification, in comparison with other five scoring systems. Design: Prospective, clinical study. Setting: Ten-bed specialized hepatogastroenterology ICU in a university hospital in Taiwan. Patients and participants: One hundred and thirty-four cirrhotic patients consecutively admitted to ICU during a 1.5-year period. Interventions: Thirty-two demographic, clinical and laboratory variables were analyzed as predictors of survival. Measurements and main results: Overall hospital mortality was 65.7%. There was a progressive and significant increase (chi(2) for trend: < 0.001) in mortality based on RIFLE classification severity. Multiple logistic regression analysis indicated that RIFLE classification and Sequential Organ Failure Assessment (SOFA) score on the first day of ICU admission were independent risk factors for hospital mortality. By using the areas under the receiver operating characteristic curve (AUROC), the RIFLE category and SOFA both indicated a good discriminative power (AUROC 0.837 +/- 0.036 and 0.917 +/- 0.025; < 0.001). Cumulative survival rates at 6-month follow-up differed significantly (< 0.05) for non-ARF vs. RIFLE-R, RIFLE-I, and RIFLE-F. Conclusion: Both SOFA and RIFLE category showed high discriminative power in predicting hospital mortality in critically ill patients with cirrhosis. The RIFLE classification is a simple and easily applied evaluative tool with good prognostic abilities.