Predictive value of RIFLE classification on prognosis of critically ill patients with acute kidney injury treated with continuous renal replacement therapy
Predictive value of RIFLE classification on prognosis of critically ill patients with acute kidney injury treated with continuous renal replacement therapy
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DOI：
10.3760/cmaj.issn.0366-6999.2009.09.004
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发表时间：
2009-05-05
影响因子：
6.1
通讯作者：
Song Yang
中科院分区：
文献类型：
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作者：
Li Wen-xiong;Chen Hui-de;Song Yang
急性肾损伤（阿基）患者开始连续性肾脏替代治疗（CRRT）的最佳时机尚未准确确定。最近提出的阿基诊断和分类的风险、损伤、衰竭、损失、终末期肾病（步枪）标准可能为临床医生提供一种方法，以根据统一指南决定开始CRRT的“最佳时机”。本研究旨在：（1）分析CRRT开始时步枪分期与CRRT开始后90天生存率的相关性，（2）进一步研究步枪分期与90天生存者恶性肾脏结局的相关性，和（3）确定根据步枪分类定义的CRRT时间对90天生存率和恶性肾脏结局的影响，方法对106例阿基危重患者的数据进行回顾性队列分析，这些患者在大学附属外科重症监护室（SICU）接受CRRT治疗6年。收集了性别、年龄、步枪分期、脓毒症、脓毒症相关器官衰竭评估（SOFA）评分、CRRT前器官衰竭数量、SICU期间CRRT时间、生存率和CRRT开始后90天的肾脏结局状况等信息。根据CRRT开始时阿基的基线严重程度，使用步枪标准，根据RIFLE分期的严重程度增加将患者分配至三组：RIFLE-R（肾功能不全风险，R）、RIFLE-I（肾损伤，1）和RIFLE-F（肾功能衰竭，F）。使用步枪标准将恶性肾脏结局分类为RIFLE-L（肾功能丧失，L）或RIFLE-E（终末期肾病，E）。在这三个RIFLE分类组中分析RIFLE分期与90天生存率之间的相关性。此外，步枪阶段和恶性肾脏的结果（RIFLE-L+RIFLF-E）在90天的survivals.Results之间的关联106例患者中的53生存到90天后开始CRRT。RIFLE-R、RIFLE-I和RIFLE-F组分别为16、22和68例，90天生存率分别为75.0%（12/16）、63.6%（14/22）和39.7%（27/68）（P
Background The optimal timing to start continuous renal replacement therapy (CRRT) for acute kidney injury (AKI) patients has not been accurately established. The recently proposed risk, injury, failure, loss, end-stage kidney disease (RIFLE) criteria for diagnosis and classification of AKI may provide a method for clinicians to decide the "optimal timing" for starting CRRT under uniform guidelines. The present study aimed: (1) to analyze the correlation between RIFLE stage at the start of CRRT and 90-day survival rate after CRRT start, (2) to further investigate the correlation of RIFLE stage with the malignant kidney outcome in the 90-day survivors, and (3) to determine the influence of the timing of CRRT defined by RIFLE classification on the 90-day survival and malignant kidney outcome in 90-day survivors.Methods A retrospective cohort analysis was performed on the data of 106 critically ill patients with AKI, treated with CRRT during a 6-year period in a university affiliated surgical intensive care unit (SICU). Information such as sex, age, RIFLE stage, sepsis, sepsis-related organ failure assessment (SOFA) score, number of organ failures before CRRT, CRRT time during SICU, survival, and kidney outcome conditions at 90 days after CRRT start was collected. According to their baseline severity of AKI at the start of CRRT, the patients were assigned to three groups according to the increasing severity of RIFLE stages: RIFLE-R (risk of renal dysfunction, R), RIFLE-I (injury to the kidney, 1) and RIFLE-F (failure of kidney function, F) using RIFLE criteria. The malignant kidney outcome was classified as RIFLE-L (loss of kidney function, L) or RIFLE-E (end-stage kidney disease, E) using RIFLE criteria. The correlation between RIFLE stage and 90-day survival rate was analyzed among these three RIFLE-categorized groups. Additionally, the association between RIFLE stage and the malignant kidney outcome (RIFLE-L+RIFLF-E) in the 90-day survivors was analyzed.Results Fifty-three of the overall 106 patients survived to 90 days after the start of CRRT. There were 16, 22 and 68 patients in RIFLE-R, RIFLE-I and RIFLE-F groups respectively with corresponding 90-day survival rate of 75.0% (12/16), 63.6% (14/22) and 39.7% (27/68) (P