Chung Kevin K, Stewart Ian J, Gisler Christopher, Simmons John W, Aden James K, Tilley Molly A, Cotant Casey L, White Christopher E, Wolf Steven E, Renz Evan M
Clinical Division, United States Army Institute of Surgical Research, Fort Sam Houston, Texas 78234-6315, USA.
J Burn Care Res. 2012 Jul-Aug;33(4):483-90. doi: 10.1097/BCR.0b013e31825aea8d.
In 2007, the Acute Kidney Injury Network (AKIN) developed a modified standard for diagnosing and classifying acute kidney injury (AKI). This classification system is a modification of the previously described risk, injury, failure, loss, and end-stage (RIFLE) criteria. Among other modifications, the AKIN staging requires an absolute serum creatinine change of 0.3 mg/dl in a 48-hour period to establish the diagnosis of AKI. The purpose of this study was to apply these new criteria in the severely burned population and to compare the prevalence, stage, and mortality impact of these criteria to the RIFLE criteria. The authors performed a retrospective analysis of consecutive patients with burns admitted to their burn center for at least 24 hours from June 2003 through December 2008. Each patient was classified by both the AKIN and RIFLE criteria by three referees. Both univariate and multivariate analyses were performed to determine the impact of the various AKI stages on mortality. A total of 1973 patients met inclusion and exclusion criteria and were included in the analysis. The average age, %TBSA, injury severity score, and percent with smoke inhalation injury were 36 ± 16, 16 ± 18, 10 ± 12, and 13%, respectively. Overall, the prevalence of AKI was 33% using the AKIN criteria and 24% using the RIFLE criteria with an associated mortality of 21 and 25%, respectively. Of those meeting criteria for AKIN stage 1 (N = 434), 41% (N = 180) would have been categorized as not having AKI on the basis of the RIFLE criteria. In this cohort of patients, mortality increased by almost 8-fold when compared with those without AKI (odds ratio 7.8 [95% confidence interval (CI) 3.7-16.2], P < .0001). The area under the receiver operator characteristic curve for in-hospital mortality was significantly higher for the AKIN criteria at 0.877 (95% CI 0.848-0.906) when compared to the RIFLE criteria at 0.838 (95% CI 0.801-0.874; P = .0007). Burn patients identified as having AKI by the AKIN criteria missed by RIFLE appear to be an important cohort. On the basis of our study, AKIN criteria may be more precise and are more predictive of death than the RIFLE criteria in this population. Prospective validation is needed.
2007年，急性肾损伤网络（AKIN）制定了一套用于诊断和分类急性肾损伤（AKI）的改良标准。该分类系统是对先前描述的风险、损伤、衰竭、丧失和终末期（RIFLE）标准的改良。在其他改良之处中，AKIN分期要求在48小时内血清肌酐绝对值变化0.3mg/dl才能确立AKI的诊断。本研究的目的是将这些新标准应用于严重烧伤人群，并比较这些标准与RIFLE标准在患病率、分期及对死亡率影响方面的差异。作者对2003年6月至2008年12月期间连续入住其烧伤中心至少24小时的烧伤患者进行了回顾性分析。由三名评审人员根据AKIN和RIFLE标准对每位患者进行分类。进行单因素和多因素分析以确定不同AKI分期对死亡率的影响。共有1973例患者符合纳入和排除标准并纳入分析。患者的平均年龄、烧伤总面积、损伤严重程度评分及吸入性损伤百分比分别为36±16岁、16±18%、10±12分和13%。总体而言，按照AKIN标准AKI的患病率为33%，按照RIFLE标准为24%，相关死亡率分别为21%和25%。在符合AKIN 1期标准的患者中（N = 434），41%（N = 180）根据RIFLE标准会被归类为未发生AKI。在这组患者中，与未发生AKI的患者相比，死亡率增加了近8倍（比值比7.8 [95%置信区间（CI）3.7 - 16.2]，P <.0001）。与RIFLE标准（0.838 [95% CI 0.801 - 0.874]；P =.0007）相比，AKIN标准用于预测院内死亡率的受试者工作特征曲线下面积显著更高，为0.877（95% CI 0.848 - 0.906）。被AKIN标准判定为发生AKI但被RIFLE标准遗漏的烧伤患者似乎是一个重要群体。基于我们的研究，在该人群中，AKIN标准可能比RIFLE标准更精确，对死亡的预测性更强。尚需进行前瞻性验证。
