RIFLE classification is predictive of short-term prognosis in critically ill patients with acute renal failure supported by extracorporeal membrane oxygenation
RIFLE classification is predictive of short-term prognosis in critically ill patients with acute renal failure supported by extracorporeal membrane oxygenation
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DOI：
10.1093/ndt/gfl326
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发表时间：
2006-10-01
影响因子：
6.1
通讯作者：
Yang, Chin-Wei
中科院分区：
文献类型：
--
作者：
Lin, Chan-Yu;Chen, Yung-Chang;Yang, Chin-Wei
背景体外膜肺氧合（ECMO）已用于危重患者，如心脏切开术后心源性休克或危及生命的呼吸衰竭患者。ECMO支持后的急性肾衰竭死亡率极高。本研究检查了ECMO治疗患者的结局，并描述了死亡率与步枪（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。这项回顾性研究分析了46例危重患者的病历，其中大多数是心切开术后心源性休克，采用ECMO治疗。16例（34.8%）患者同时接受ECMO和连续性肾脏替代治疗。总死亡率为65.2%（30/46）。根据步枪分级的严重程度，观察到死亡率的进行性和显著性增加（趋势卡方（2），P < 0.001）。Hosmer和Lemeshow拟合优度检验表明，步枪类别具有良好的拟合性。通过应用受试者工作特征曲线下面积（AUROC），步枪分类工具具有良好的区分能力（AUROC 0.868 ± 0.068，P < 0.001）。非ARF组与RIFLE-I组、RIFLE-F组、RIFLE-R组与步枪组出院后6个月随访时的累积生存率差异有统计学意义（P < 0.05）。这项调查证实，ECMO支持的危重患者预后严重。步枪分类是一种简单、可重复和易于应用的评估工具，具有良好的预后能力，可为患者家属和医生提供客观信息，并补充临床预后判断。
Background. Extracorporeal membrane oxygenation (ECMO) has been utilized for critically ill patients, such as those with post-cardiotomy cardiogenic shock or life-threatening respiratory failure. Acute renal failure following ECMO support has an extremely elevated mortality rate. This study examined the outcomes of patients treated with ECMO and characterized the association between mortality and RIFLE (risk of renal failure, injury to the kidney, failure of kidney function, loss of kidney function and end-stage renal failure) classification.Methods. This retrospective study analysed the medical records of 46 critically ill patients-most had post-cardiotomy cardiogenic shock-treated by ECMO. Sixteen patients (34.8%) were treated with both ECMO and continuous renal replacement therapies.Results. The overall mortality rate was 65.2% (30/46). A progressive and significant increase (chi(2) for trend, P < 0.001) was observed for mortality based on RIFLE classification severity. The Hosmer and Lemeshow goodness-of-fit test demonstrated that the RIFLE category has a good fit. By applying the area under the receiver operating characteristic curve (AUROC), the RIFLE classification tool had good discriminative power (AUROC 0.868 +/- 0.068, P < 0.001). Cumulative survival rates at 6 months follow-up following hospital discharge differed significantly (P < 0.05) for non-ARF vs RIFLE-I and RIFLE-F, and RIFLE-R vs RIFLE-F.Conclusion. This investigation confirms that the prognosis for critically ill patients supported by ECMO is grave. The RIFLE category is a simple, reproducible and easily applied evaluation tool with good prognostic capability that might generate objective information for patient families and physicians and supplements the clinical judgment of prognosis.