Department of Intensive Care Medicine, Royal Perth Hospital, Perth, W.A., Australia.
Nephron Clin Pract. 2010;115(1):c59-65. doi: 10.1159/000286351. Epub 2010 Feb 19.
Risk, Injury, Failure, Loss, and End-Stage (RIFLE) criteria have been proposed as a standard definition of acute kidney injury (AKI). The most severe form of AKI, class F AKI, can be defined by either severe oliguria or a 3-fold increase in serum creatinine concentrations. We hypothesized that the outcomes of patients with these 2 alternative criteria of severe AKI were different.
A prospective cohort study was conducted of all patients attaining RIFLE class F AKI during a 12-month period in a tertiary critical care facility.
Among a total of 2,379 critical care admissions, 129 (5.4%) fulfilled the serum creatinine criteria without oliguria (RIFLE class F) and 99 (4.2%) fulfilled oliguric (RIFLE class F) AKI criteria. Patients with oliguric AKI suffered a more severe disease process than nonoliguric AKI. Oliguric AKI was associated with a significantly higher risk of requiring acute dialysis (70.7 vs. 22.4%, p = 0.001), long-term dialysis >90 days (15 vs. 1.9%, p = 0.006), and hospital mortality (adjusted hazard ratio 3.33, 95% confidence interval, p = 0.001) than nonoliguric AKI.
Oliguric RIFLE class F AKI is a more severe form of AKI than nonoliguric class F AKI. These 2 forms of AKI should be considered separately when AKI is evaluated in a clinical trial.
风险、损伤、衰竭、丧失和终末期（RIFLE）标准已被提议作为急性肾损伤（AKI）的标准定义。AKI 最严重的形式，即 F 级 AKI，可以通过严重少尿或血清肌酐浓度增加 3 倍来定义。我们假设这两种严重 AKI 替代标准的患者结局不同。
对 12 个月内在三级重症监护病房达到 RIFLE F 级 AKI 的所有患者进行前瞻性队列研究。
在总共 2379 例重症监护入院患者中，129 例（5.4%）符合无少尿（RIFLE 分级 F）的血清肌酐标准，99 例（4.2%）符合少尿（RIFLE 分级 F）的 AKI 标准。少尿性 AKI 患者的疾病过程比非少尿性 AKI 患者更严重。少尿性 AKI 与需要急性透析的风险显著增加相关（70.7% vs. 22.4%，p = 0.001），需要长期透析>90 天（15% vs. 1.9%，p = 0.006）和医院死亡率（调整后的危险比 3.33，95%置信区间，p = 0.001）高于非少尿性 AKI。
少尿性 RIFLE 分级 F AKI 是比非少尿性 F 级 AKI 更严重的 AKI 形式。在临床试验中评估 AKI 时，应分别考虑这两种 AKI 形式。
