Acute kidney injury in the intensive care unit according to RIFLE
Acute kidney injury in the intensive care unit according to RIFLE
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DOI：
10.1097/01.ccm.0000277041.13090.0a
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发表时间：
2007-08-01
影响因子：
8.8
通讯作者：
Chang, Rene W. S.
中科院分区：
文献类型：
--
作者：
Ostermann, Marlies;Chang, Rene W. S.
目的：应用 RIFLE 标准“风险”、“损伤”和“失败”来衡量入住重症监护病房的患者急性肾损伤的严重程度，并评估其他预后因素的重要性。设计：利雅得重症监护计划数据库的回顾性分析。背景：利雅得重症监护病房计划数据库，包含美国 22 个重症监护病房收治的 41,972 名患者 1989 年至 1999 年间，英国和德国。 患者：15,019 名 (35.8%) 患者发生了 RIFLE 分类定义的急性肾损伤； 7,207 名患者 (17.2%) 存在风险，4,613 名患者 (11%) 受伤，3,199 名患者 (7.6%) 失败。结果发现，797 名 (2.3%) 患者在入住重症监护病房时患有终末期透析依赖性肾衰竭。干预措施：无。测量和主要结果。有风险、损伤和失败分类的患者的医院死亡率分别为 20.9%、45.6% 和 56.8%，而无急性肾损伤患者的医院死亡率为 8.4%。医院死亡的独立危险因素是年龄（比值比 1.02）；进入重症监护病房时急性生理学和慢性健康评估 11 分（比值比 1.10）；先前存在终末期疾病（优势比 1.17）；机械通气（优势比 1.52）； RIFLE 类别为风险（优势比 1.40）、伤害（优势比 1.96）和失败（优势比 1.59）；失败器官的最大数量（比值比 2.13）；急诊手术后入院（优势比 3.08）；和非手术入院（优势比 3.92）。急性肾损伤的肾脏替代治疗不是医院死亡的独立危险因素。结论：RIFLE分类适合重症监护病房急性肾损伤的定义。急性肾损伤与医院结局之间存在关联，但相关器官衰竭、非手术入院和急诊手术后入院对预后的影响大于急性肾损伤严重程度。
Objectives: To apply the RIFLE criteria "risk," "injury," and "failure" for severity of acute kidney injury to patients admitted to the intensive care unit and to evaluate the significance of other prognostic factors.Design: Retrospective analysis of the Riyadh Intensive Care Program database.Setting: Riyadh Intensive Care Unit Program database of 41,972 patients admitted to 22 intensive care units in the United Kingdom and Germany between 1989 and 1999.Patients: Acute kidney injury as defined by the RIFLE classification occurred in 15,019 (35.8%) patients; 7,207 (17.2%) patients were at risk, 4,613 (11%) had injury, and 3,199 (7.6%) had failure. It was found that 797 (2.3%) patients had end-stage dialysis-dependent renal failure when admitted to an intensive care unit.Interventions: None.Measurements and Main Results. Patients with risk, injury, and failure classifications had hospital mortality rates of 20.9%, 45.6%, and 56.8%, respectively, compared with 8.4% among patients without acute kidney injury. Independent risk factors for hospital mortality were age (odds ratio 1.02); Acute Physiology and Chronic Health Evaluation 11 score on admission to intensive care unit (odds ratio 1.10); presence of preexisting end-stage disease (odds ratio 1.17); mechanical ventilation (odds ratio 1.52); RIFLE categories risk (odds ratio 1.40), injury (odds ratio 1.96), and failure (odds ratio 1.59); maximum number of failed organs (odds ratio 2.13); admission after emergency surgery (odds ratio 3.08); and nonsurgical admission (odds ratio 3.92). Renal replacement therapy for acute kidney injury was not an independent risk factor for hospital mortality.Conclusions: The RIFLE classification was suitable for the definition of acute kidney injury in intensive care units. There was an association between acute kidney injury and hospital outcome, but associated organ failure, nonsurgical admission, and admission after emergency surgery had a greater impact on prognosis than severity of acute kidney injury.