Unit of Critical Care, Imperial College, Royal Brompton Hospital, London, SW3 6NP, UK.
J Crit Care. 2013 Aug;28(4):389-96. doi: 10.1016/j.jcrc.2012.12.008. Epub 2013 Jun 3.
The epidemiology of acute kidney injury (AKI) after cardiac surgery depends on the definition used. Our aims were to evaluate the Risk/Injury/Failure/Loss/End-stage (RIFLE) criteria, the AKI Network (AKIN) classification, and the Kidney Disease: Improving Global Outcomes (KDIGO) classification for AKI post-cardiac surgery and to compare the outcome of patients on renal replacement therapy (RRT) with historical data.
Retrospective analysis of 1881 adults who had cardiac surgery between May 2006 and April 2008 and determination of the maximum AKI stage according to the AKIN, RIFLE, and KDIGO classifications.
The incidence of AKI using the AKIN and RIFLE criteria was 25.9% and 24.9%, respectively, but individual patients were classified differently. The area under the receiver operating characteristic curve for hospital mortality was significantly higher using the AKIN compared with the RIFLE criteria (0.86 vs 0.78, P = .0009). Incidence and outcome of AKI according to the AKIN and KDIGO classification were identical. The percentage of patients who received RRT was 6.2% compared with 2.7% in 1989 to 1990. The associated hospital mortality fell from 82.9% in 1989 to 1990 to 15.6% in 2006 to 2008.
The AKIN classification correlated better with mortality than did the RIFLE criteria. Mortality of patients needing RRT after cardiac surgery has improved significantly during the last 20 years.
心脏手术后急性肾损伤（AKI）的流行病学取决于所使用的定义。我们的目的是评估风险/损伤/衰竭/损失/终末期（RIFLE）标准、急性肾损伤网络（AKIN）分类和肾脏疾病：改善全球预后（KDIGO）分类用于心脏手术后 AKI，并将接受肾脏替代治疗（RRT）的患者的预后与历史数据进行比较。
回顾性分析 2006 年 5 月至 2008 年 4 月期间接受心脏手术的 1881 例成年人，并根据 AKIN、RIFLE 和 KDIGO 分类确定最大 AKI 分期。
使用 AKIN 和 RIFLE 标准，AKI 的发生率分别为 25.9%和 24.9%，但个别患者的分类不同。与 RIFLE 标准相比，AKIN 标准的医院死亡率的受试者工作特征曲线下面积显著更高（0.86 对 0.78，P=0.0009）。根据 AKIN 和 KDIGO 分类，AKI 的发生率和预后相同。接受 RRT 的患者比例为 6.2%，而 1989 年至 1990 年为 2.7%。与 1989 年至 1990 年相比，2006 年至 2008 年需要 RRT 的患者的相关医院死亡率从 82.9%下降至 15.6%。
与 RIFLE 标准相比，AKIN 分类与死亡率的相关性更好。心脏手术后需要 RRT 的患者的死亡率在过去 20 年中显著改善。
