Evaluation of the prognostic value of the risk, injury, failure, loss and end-stage renal failure (RIFLE) criteria for acute kidney injury
Evaluation of the prognostic value of the risk, injury, failure, loss and end-stage renal failure (RIFLE) criteria for acute kidney injury
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DOI：
10.1111/j.1440-1797.2008.00950.x
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发表时间：
2008-08-01
期刊：
影响因子：
2.5
通讯作者：
Lavilla, Francisco J.
中科院分区：
文献类型：
--
作者：
Valdivieso, Jose R. Perez;Bes-Rastrollo, Maira;Lavilla, Francisco J.
目的：专家们对使用风险、损伤、衰竭、损失和终末期肾衰竭（步枪）标准作为预后评分系统进行了争论。我们研究了住院死亡率和步枪标准之间的关联，并讨论了其准确性作为一个预后factor.Methods：在这项前瞻性研究中，我们分析了收集的数据从一个队列的956例患者在西班牙三级医院1998年1月至2006年4月。计算死亡率的风险比和60天内的生存曲线。结果：排除53例患者，最终分析了903例患者。我们根据他们入院时达到的最高步枪等级将他们分组。根据肾小球滤过率标准评估步枪分级。我们发现住院死亡风险增加。考克斯比例风险模型显示，步枪分类风险、损伤和失败是显著的预测因素（风险比分别为2.77、3.23和3.52;趋势P值为0.005）。根据Liano评分值（疾病的严重程度）和步枪类的参与者的交叉分类的多变量分析显示，在医院mortality.Conclusion：在这个人群中，在急性肾损伤（阿基）发作期间的住院死亡率的风险与步枪类呈正相关。我们发现，步枪分类系统在预测阿基患者60天内的住院死亡率方面具有区分能力，但并不比特定的阿基预测模型更好。然而，两者的组合使用可以给出更稳健的预后系统。
Aim: The experts have argued about the use of the risk, injury, failure, loss and end-stage renal failure (RIFLE) criteria as a prognosis scoring system. We examined the association between in-hospital mortality and the RIFLE criteria, and discussed its accuracy as a prognosis factor.Methods: In this prospective study, we analysed the data gathered from a cohort of 956 patients admitted in a Spanish tertiary hospital between January 1998 and April 2006. Hazard ratios for mortality, and survival curves within 60 days were calculated. Discrimination and calibration of the model were also assessed.Results: Excluding 53 patients, 903 patients were finally analysed. We classified them into groups according to the maximum RIFLE class reached during their admission. The RIFLE class was assessed by the glomerular filtration rate criterion. We found an increase in the in-hospital mortality risk. Cox proportional hazard models showed that RIFLE classes risk, injury, and failure were significant predictive factors (hazard ratios were 2.77, 3.23 and 3.52, respectively; P for trend was 0.005). The multivariate analyses from the cross-classification of the participants according to Liano score values (severity of illness) and RIFLE classes showed additive effects of the exposures on in-hospital mortality.Conclusion: In this population, the risk of in-hospital mortality during the acute kidney injury (AKI) episode was positively associated with RIFLE classes. We showed that the RIFLE classification system had discriminative power in predicting hospital mortality within 60 days in AKI patients, but not better than a specific AKI predictive model. However, a combined use of both may give a more robust prognosis system.