根据 RIFLE（风险、损伤、衰竭、丧失、终末期）标准，严重急性肾损伤会影响肺移植的死亡率。
Severe acute kidney injury according to the RIFLE (risk, injury, failure, loss, end stage) criteria affects mortality in lung transplantation.
机构信息
Division of Cardiac Surgery, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
出版信息
J Heart Lung Transplant. 2011 Oct;30(10):1161-8. doi: 10.1016/j.healun.2011.04.013. Epub 2011 May 28.
BACKGROUND
The RIFLE criteria (risk, injury, failure, loss, end stage) are new consensus definitions for acute kidney injury (AKI) associated with increased mortality; however, they have not been applied in lung transplantation (LTx). Using the RIFLE criteria, we examined the effect of AKI on outcomes and cost in LTx.
METHODS
We retrospectively reviewed all LTx patients at our institution since the lung allocation score (LAS) system was initiated (May 2005-August 2010). Using the Modification of Diet in Renal Disease formula, we assigned appropriate RIFLE class (R, I, F) comparing baseline creatinine to peak levels in the first 7 days after LTx. Generalized linear models assessed the effect of AKI on in-hospital and 1-year mortality. Hospital charges were used to examine the financial effect of AKI.
RESULTS
During the study, 106 LTx were performed. Excluding patients bridged to LTx with extracorporeal membrane oxygenation, 84 (86%) lived 1 year. Median LAS was 37.1 (interquartile range, 34.1-45.2). RIFLE status was I or F in 39 (36.7%), and 14 (13.2%) required renal replacement therapy (RRT). After adjusting for LAS, RIFLE-F had an increased relative rate (RR) of in-hospital mortality (RR, 4.76, 95% confidence interval [CI], 1.65-13.7, p = 0.004) and 1-year mortality (RR, 3.17, 95% CI 1.55-6.49, p = 0.002). RIFLE-R and I were not associated with higher in-hospital or 1-year mortality. Post-operative RRT was associated with increased in-hospital (RR, 28.2; 95% CI, 6.18-128.1; p < 0.001) and 1-year mortality (RR, 4.97; 95% CI, 1.54-16.0; p < 0.001). AKI patients had higher median hospital charges of $168,146 vs $143,551 for no AKI (p = 0.02).
CONCLUSIONS
This study shows high rates of AKI using the new RIFLE criteria in LTx. RIFLE-F is associated with higher in-hospital and 1-year mortality. Less severe degrees of AKI are not associated with increased mortality. The financial burden associated with AKI is significant.
背景
RIFLE 标准（风险、损伤、衰竭、丧失、终末期）是新的急性肾损伤（AKI）与死亡率增加相关的共识定义；然而，它们尚未在肺移植（LTx）中应用。使用 RIFLE 标准，我们检查了 AKI 对 LTx 结果和成本的影响。
方法
我们回顾性分析了自肺分配评分（LAS）系统启动以来（2005 年 5 月至 2010 年 8 月）我院所有 LTx 患者。使用改良肾脏病饮食公式，我们根据基线肌酐与 LTx 后第 7 天内的峰值水平将适当的 RIFLE 分级（R、I、F）分配。广义线性模型评估 AKI 对住院和 1 年死亡率的影响。使用医院费用来检查 AKI 的财务影响。
结果
在研究期间，进行了 106 例 LTx。排除体外膜氧合桥接至 LTx 的患者，84 例（86%）存活 1 年。中位 LAS 为 37.1（四分位间距，34.1-45.2）。39 例（36.7%）为 I 或 F 级 RIFLE 状态，14 例（13.2%）需要肾脏替代治疗（RRT）。在调整 LAS 后，RIFLE-F 住院死亡率（RR，4.76，95%置信区间[CI]，1.65-13.7，p=0.004）和 1 年死亡率（RR，3.17，95%CI 1.55-6.49，p=0.002）的相对风险增加。RIFLE-R 和 I 与较高的住院或 1 年死亡率无关。术后 RRT 与住院（RR，28.2；95%CI，6.18-128.1；p<0.001）和 1 年死亡率（RR，4.97；95%CI，1.54-16.0；p<0.001）增加相关。AKI 患者的中位医院费用为 168146 美元，而非 AKI 患者为 143551 美元（p=0.02）。
结论
本研究显示，在 LTx 中使用新的 RIFLE 标准，AKI 发生率较高。RIFLE-F 与较高的住院和 1 年死亡率相关。较不严重程度的 AKI 与死亡率增加无关。AKI 相关的财务负担是显著的。
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