Department of Emergency Medicine, University of Alabama School of Medicine, Birmingham, AL, USA.
Nephrol Dial Transplant. 2013 Jun;28(6):1447-54. doi: 10.1093/ndt/gfs533. Epub 2013 Jan 25.
The Kidney Disease: Improving Global Outcomes (KDIGO) system for classification of acute kidney injury (AKI) severity utilizes a staging schema based on relative changes in serum creatinine (sCr) concentration and urine output. This study compares the in-hospital mortality associated with KDIGO-defined AKI stages and AKI stages defined by absolute sCr increases ('Delta-Creatinine').
The study included an analysis of hospital discharge and laboratory data from an urban academic medical center over a 1-year period. Including adult in-patients undergoing two or more sCr measurements, the study classified AKI stages using the KDIGO consensus standards as well as absolute increases in sCr ('Delta-Creatinine'); Stage 0, sCr increase <0.3 mg/dL, Stage 1, sCr increase 0.3-0.69 mg/dL, Stage 2, sCr increase 0.7-1.19 mg/dL and Stage 3, sCr increase ≥1.2 mg/dL or initiation of renal replacement therapy. The Delta-Creatinine cut-points were defined to optimize discrimination of in-patient mortality between AKI stages. The associations between KDIGO and Delta-Creatinine AKI stages and in-hospital mortality were compared using the time-dependent hazard ratios (HRs) and the net reclassification improvement (NRI).
Of the 19 878 hospitalizations included in the analysis, the prevalence of AKI was 23.4% as defined by the KDIGO criteria. The Delta-Creatinine system discriminated the differences between adjacent AKI stages (i.e. 1 versus 0, 2 versus 1, 3 versus 3) earlier than the KDIGO system. The NRI between Delta-Creatinine and KDIGO for the prediction of mortality was 9.7% [95% confidence interval (CI) 6.2-13.2%]. Stratification by age, sex, race and history of chronic kidney disease (CKD) resulted in similar NRI values.
The Delta-Creatinine system, based on the absolute increases in sCr, provides a promising alternative to the KDIGO system for characterizing the severity of AKI and its associations with in-patient mortality.
肾脏病：改善全球预后（KDIGO）急性肾损伤（AKI）严重程度分类系统利用基于血清肌酐（sCr）浓度和尿量相对变化的分期方案。本研究比较了 KDIGO 定义的 AKI 分期和基于绝对 sCr 升高的 AKI 分期（“Delta-Creatinine”）与住院死亡率的关系。
本研究分析了 1 年内城市学术医疗中心的住院和实验室数据。包括接受两次或更多次 sCr 测量的成年住院患者，本研究使用 KDIGO 共识标准以及绝对 sCr 升高（“Delta-Creatinine”）来对 AKI 分期进行分类；分期 0，sCr 升高<0.3mg/dL；分期 1，sCr 升高 0.3-0.69mg/dL；分期 2，sCr 升高 0.7-1.19mg/dL；分期 3，sCr 升高≥1.2mg/dL 或开始肾脏替代治疗。Delta-Creatinine 切点定义为优化 AKI 分期与住院死亡率之间的区分度。使用时间依赖性风险比（HR）和净重新分类改善（NRI）比较 KDIGO 和 Delta-Creatinine AKI 分期与住院死亡率之间的关系。
在纳入分析的 19878 例住院患者中，KDIGO 标准定义的 AKI 患病率为 23.4%。Delta-Creatinine 系统比 KDIGO 系统更早地区分了相邻 AKI 分期之间的差异（即 1 期与 0 期、2 期与 1 期、3 期与 3 期）。Delta-Creatinine 与 KDIGO 对死亡率预测的 NRI 为 9.7%（95%CI 6.2-13.2%）。按年龄、性别、种族和慢性肾脏病（CKD）史进行分层，NRI 值相似。
基于 sCr 绝对升高的 Delta-Creatinine 系统为描述 AKI 的严重程度及其与住院死亡率的关系提供了一种有前途的替代 KDIGO 系统的方法。
