RIFLE标准和急性肾损伤网络（AKIN）标准对多器官功能障碍综合征危重症患者医院死亡率预测的临床准确性

Clinical accuracy of RIFLE and Acute Kidney Injury Network (AKIN) criteria for predicting hospital mortality in critically ill patients with multi-organ dysfunction syndrome.

作者信息

Ratanarat Ranistha, Skulratanasak Peenida, Tangkawattanakul Nattakarn, Hantaweepant Chattree

机构信息

Division of Critical Care Medicine, Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.

出版信息

J Med Assoc Thai. 2013 Feb;96 Suppl 2:S224-31.

PMID:23590046

Abstract

BACKGROUND

The Acute Dialysis Quality Initiative (ADQI) group developed RIFLE criteria and the Acute Kidney Injury Network published AKIN classification that modified form RIFLE criteria.

OBJECTIVE

The authors aimed to compare the ability of RIFLE and AKIN criteria to measure the incidence of acute kidney injury (AKI) and to predict clinical outcomes in critically illpatients.

MATERIAL AND METHOD

A retrospective cohort study, in Siriraj Hospital, Bangkok. The critically ill patients admitted to medical intensive care unit (ICU) during January 2006-December 2008 were classified according to the maximum RIFLE and AKIN classification reached during their hospital stay Demographic data, hospital mortality, hospital length of stay, need of renal replacement therapy was collected.

RESULTS

Three hundred patients were included in this study, AKI occurred in 200 (66.7%) patients: Risk 12.7%, Injury 20.7%, Failure 33.3% defined by RIFLE criteria. According to AKIN criteria, AKI occurred 230 (76.7%) patients: stage 1 16%, stage 2 13.3% and stage 3 47.3%. AKIN classification was diagnosed AKI, approximately 10% more than RIFLE (p < 0.001). The hospital mortality was 51.7% and the mortality in patients with AKI was significantly higher than patients without AKI (p < 0.001). The predictive ability using the AUC-ROC showed poor discrimination for the prediction of mortality of both RIFLE and AKIN: 0.63 and 0.69, respectively. However, AKIN showed superior prediction of mortality than RIFLE (p = 0.003). The APACHE II had the best discriminative accuracy for mortality (AUC = 0.80), followed by the SAPS3 scores (AUC = 0.77) and SAPS2 (AUC = 0.76).

CONCLUSION

AKIN criteria improved sensitivity for detection of AKI and its discrimination for prediction of in-hospital mortality was better than that of RIFLE criteria. However, APACHE II had the best discriminative value for prediction of mortality in the critically ill patients.

摘要

背景

急性透析质量倡议（ADQI）小组制定了RIFLE标准，急性肾损伤网络发布了对RIFLE标准进行修改的AKIN分类。

目的

作者旨在比较RIFLE标准和AKIN标准衡量急性肾损伤（AKI）发病率以及预测危重症患者临床结局的能力。

材料与方法

在曼谷诗里拉吉医院进行一项回顾性队列研究。将2006年1月至2008年12月期间入住医学重症监护病房（ICU）的危重症患者按照其住院期间达到的最高RIFLE和AKIN分类进行分类。收集人口统计学数据、医院死亡率、住院时间、肾脏替代治疗需求。

结果

本研究纳入300例患者，200例（66.7%）发生AKI：按照RIFLE标准，风险期12.7%，损伤期20.7%，衰竭期33.3%。按照AKIN标准，230例（76.7%）发生AKI：1期16%，2期13.3%，3期47.3%。AKIN分类诊断出的AKI比RIFLE标准约多10%（p<0.001）。医院死亡率为51.7%，AKI患者的死亡率显著高于未发生AKI的患者（p<0.001）。使用AUC-ROC的预测能力显示，RIFLE和AKIN对死亡率的预测区分度均较差，分别为0.63和0.69。然而，AKIN对死亡率的预测优于RIFLE（p=0.003）。急性生理与慢性健康状况评分系统II（APACHE II）对死亡率的判别准确性最佳（AUC=0.80），其次是序贯器官衰竭评估（SAPS3）评分（AUC=0.77）和SAPS2（AUC=0.76）。