Cruz Dinna N, Bolgan Irene, Perazella Mark A, Bonello Monica, de Cal Massimo, Corradi Valentina, Polanco Natalia, Ocampo Catalina, Nalesso Federico, Piccinni Pasquale, Ronco Claudio
Department of Nephrology and Intensive Care, San Bortolo Hospital, Vicenza, Italy.
Clin J Am Soc Nephrol. 2007 May;2(3):418-25. doi: 10.2215/CJN.03361006. Epub 2007 Mar 27.
Acute kidney injury (AKI) in the intensive care unit (ICU) is associated with an enhanced mortality. The Acute Dialysis Quality Initiative group has proposed the RIFLE (Risk-Injury-Failure-Loss-ESRD) classification to standardize the approach to AKI. This study was performed to estimate the AKI incidence in ICU patients in northeastern Italy and describe clinical characteristics and outcomes of patients with AKI on the basis of their RIFLE class. A prospective multicenter observational study was performed of patients who fulfilled AKI criteria in 19 ICU in northeastern Italy. Data were analyzed using multivariate logistic regression and survival curve analysis. Of 2164 ICU patients who were admitted during the study period, 234 (10.8%; 95% confidence interval 9.5 to 12.1%) developed AKI; 19% were classified as risk (R), 35% as injury (I), and 46% as failure (F). Preexisting kidney disease was present in 36.8%. The most common causes of AKI were prerenal causes (38.9%) and sepsis (25.6%). At diagnosis of AKI, median serum creatinine and urine output were 2.0 mg/dl and 1100 ml/d, respectively. ICU mortality was 49.5% in class F, 29.3% in I, and 20% in R. Independent risk factors for mortality included RIFLE class, sepsis, and need for renal replacement therapy, whereas a postsurgical cause of AKI, exposure to nephrotoxins, higher serum creatinine, and urine output were associated with lower mortality risk. In this study, AKI incidence in the ICU was between 9 and 12%, with 3.3% of ICU patients requiring renal replacement therapy. Sepsis was a significant contributing factor. Overall mortality was between 30 and 42%, and was highest among those in RIFLE class F.
重症监护病房（ICU）中的急性肾损伤（AKI）与死亡率升高相关。急性透析质量倡议组织提出了RIFLE（风险-损伤-衰竭-丧失-终末期肾病）分类法，以规范AKI的处理方法。本研究旨在估算意大利东北部ICU患者中AKI的发病率，并根据RIFLE分级描述AKI患者的临床特征和转归。对意大利东北部19个ICU中符合AKI标准的患者进行了一项前瞻性多中心观察性研究。采用多因素逻辑回归和生存曲线分析对数据进行分析。在研究期间收治的2164例ICU患者中，234例（10.8%；95%置信区间9.5%至12.1%）发生了AKI；19%被分类为风险（R）级，35%为损伤（I）级，46%为衰竭（F）级。36.8%的患者存在既往肾脏疾病。AKI最常见的病因是肾前性病因（38.9%）和脓毒症（25.6%）。在诊断AKI时，血清肌酐中位数和尿量分别为2.0mg/dl和1100ml/d。F级患者的ICU死亡率为49.5%，I级为29.3%，R级为20%。死亡的独立危险因素包括RIFLE分级、脓毒症和肾脏替代治疗需求，而AKI的术后病因、接触肾毒素、较高的血清肌酐和尿量与较低的死亡风险相关。在本研究中，ICU中AKI的发病率在9%至12%之间，3.3%的ICU患者需要肾脏替代治疗。脓毒症是一个重要的促成因素。总体死亡率在30%至42%之间，在RIFLE F级患者中最高。
