A comparison of observed versus estimated baseline creatinine for determination of RIFLE class in patients with acute kidney injury
A comparison of observed versus estimated baseline creatinine for determination of RIFLE class in patients with acute kidney injury
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DOI：
10.1093/ndt/gfp159
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发表时间：
2009-09-01
影响因子：
6.1
通讯作者：
Kellum, John A.
中科院分区：
文献类型：
--
作者：
Bagshaw, Sean M.;Uchino, Shigehiko;Kellum, John A.
方法.分析了来自肾脏开始和结束支持治疗（BEST Kidney）研究的数据，该研究是一项前瞻性观察性研究，来自23个国家的54个重症阿基患者的ICU。使用观察到的（o）发病前SCr值和估计的（e）基线SCr值确定步枪类别。通过相关系数和Bland-Altman图评价一致性。根据慢性肾脏疾病（CKD）状态进行敏感性分析。76%的患者（n = 1327）有病前基线SCr，1314例有完整的评估数据。46%患有CKD。oSCr和eSCr的中位（IQR）值分别为97 μ mol/L（79-150）和88 μ mol/L（71-97）。在ICU入院和研究入组时测定的oSCr和eSCr仅显示出适度的相关性（r = 0.49，r = 0.39）。在ICU入院和研究入组时，与oSCr相比，eSCr将18.8%和11.7%的患者错误分类为阿基。排除CKD患者改善了ICU入院和研究入组时oSCr和eSCr之间的相关性（r = 0.90，r = 0.84），分别导致6.6%和4.0%的错误分类。虽然有限，但当病前SCr不可用时，通过MDRD方程估计基线SCr似乎仅在病前GFR接近正常时才能合理地确定步枪类别。然而，在疑似CKD患者中，使用MDRD估计基线SCr高估了阿基的发生率，不太可能使用。需要改进方法来估计基线SCr。
Methods. Data from the Beginning and Ending Supportive Therapy for the Kidney (BEST Kidney) study, a prospective observational study from 54 ICUs in 23 countries of critically ill patients with severe AKI, were analysed. The RIFLE class was determined by using observed (o) pre-morbid and estimated (e) baseline SCr values. Agreement was evaluated by correlation coefficients and Bland-Altman plots. Sensitivity analysis by chronic kidney disease (CKD) status was performed.Results. Seventy-six percent of patients (n = 1327) had a pre-morbid baseline SCr, and 1314 had complete data for evaluation. Forty-six percent had CKD. The median (IQR) values were 97 mu mol/L (79-150) for oSCr and 88 mu mol/L (71-97) for eSCr. The oSCr and eSCr determined at ICU admission and at study enrolment showed only a modest correlation (r = 0.49, r = 0.39). At ICU admission and study enrolment, eSCr misclassified 18.8% and 11.7% of patients as having AKI compared with oSCr. Exclusion of CKD patients improved the correlation between oSCr and eSCr at ICU admission and study enrolment (r = 0.90, r = 0.84) resulting in 6.6% and 4.0% being misclassified, respectively.Conclusions. While limited, estimating baseline SCr by the MDRD equation when pre-morbid SCr is unavailable would appear to perform reasonably well for determining the RIFLE categories only if and when pre-morbid GFR was near normal. However, in patients with suspected CKD, the use of MDRD to estimate baseline SCr overestimates the incidence of AKI and should not likely be used. Improved methods to estimate baseline SCr are needed.