Department of Anesthesiology Critical Care Medicine, Childrens Hospital Los Angeles, Los Angeles, CA, USA.
Crit Care Med. 2010 Mar;38(3):933-9. doi: 10.1097/CCM.0b013e3181cd12e1.
OBJECTIVE: To evaluate the ability of the RIFLE criteria to characterize acute kidney injury in critically ill children. DESIGN: Retrospective analysis of prospectively collected clinical data. SETTING: Multidisciplinary, tertiary care, 20-bed pediatric intensive care unit. PATIENTS: All 3396 admissions between July 2003 and March 2007. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: A RIFLE score was calculated for each patient based on percent change of serum creatinine from baseline (risk = serum creatinine x1.5; injury = serum creatinine x2; failure = serum creatinine x3). Primary outcome measures were mortality and intensive care unit length of stay. Logistic and linear regressions were performed to control for potential confounders and determine the association between RIFLE score and mortality and length of stay, respectively.One hundred ninety-four (5.7%) patients had some degree of acute kidney injury at the time of admission, and 339 (10%) patients had acute kidney injury develop during the pediatric intensive care unit course. Almost half of all patients with acute kidney injury had their maximum RIFLE score within 24 hrs of intensive care unit admission, and approximately 75% achieved their maximum RIFLE score by the seventh intensive care unit day. After regression analysis, any acute kidney injury on admission and any development of or worsening of acute kidney injury during the pediatric intensive care unit stay were independently associated with increased mortality, with the odds of mortality increasing with each grade increase in RIFLE score (p < .01). Patients with acute kidney injury at the time of admission had a length of stay twice that of those with normal renal function, and those who had any acute kidney injury develop during the pediatric intensive care unit course had a four-fold increase in pediatric intensive care unit length of stay. Also, other than being admitted with RIFLE risk score, an independent relationship between any acute kidney injury at the time of pediatric intensive care unit admission, any acute kidney injury present during the pediatric intensive care unit course, or any worsening RIFLE scores during the pediatric intensive care unit course and increased pediatric intensive care unit length of stay were identified after controlling for the same high-risk covariates (p < .01). CONCLUSIONS: RIFLE criteria serves well to describe acute kidney injury in critically ill pediatric patients.
目的：评估 RIFLE 标准在描述危重病儿童急性肾损伤中的能力。
设计：前瞻性收集临床数据的回顾性分析。
地点：多学科、三级护理、20 张病床的儿科重症监护病房。
患者：2003 年 7 月至 2007 年 3 月期间的所有 3396 例入院患者。
干预措施：无。
测量和主要结果：根据血清肌酐从基线的变化百分比（风险=血清肌酐 x1.5；损伤=血清肌酐 x2；衰竭=血清肌酐 x3）为每位患者计算 RIFLE 评分。主要结局指标为死亡率和重症监护病房住院时间。进行逻辑和线性回归以控制潜在混杂因素，并确定 RIFLE 评分与死亡率和住院时间之间的关联。194 名（5.7%）患者在入院时存在某种程度的急性肾损伤，339 名（10%）患者在儿科重症监护病房期间发生急性肾损伤。几乎所有急性肾损伤患者的最大 RIFLE 评分都在重症监护病房入院后 24 小时内出现，大约 75%的患者在重症监护病房第 7 天达到最大 RIFLE 评分。经过回归分析，入院时的任何急性肾损伤以及儿科重症监护病房期间的急性肾损伤的发展或恶化都与死亡率增加独立相关，随着 RIFLE 评分的每级增加，死亡率的几率增加（p <.01）。入院时患有急性肾损伤的患者的住院时间是肾功能正常患者的两倍，而在儿科重症监护病房期间发生任何急性肾损伤的患者的儿科重症监护病房住院时间增加了四倍。此外，除了入院时的 RIFLE 风险评分外，在控制相同的高危混杂因素后，儿科重症监护病房入院时的任何急性肾损伤、儿科重症监护病房期间存在的任何急性肾损伤或儿科重症监护病房期间 RIFLE 评分的任何恶化与儿科重症监护病房住院时间延长之间也存在独立关系（p <.01）。
结论：RIFLE 标准很好地描述了危重病儿童的急性肾损伤。
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