Wahrhaftig Kátia M, Correia Luis C L, Matias Denise, De Souza Carlos A M
Department of Postgraduate Medicine and Human Health, Bahia School of Medicine and Public Health (EBMSP), Avenida D. João VI 275, PAV.II, 2° Andar, Sala 07, Brotas, 40.290-000 Salvador, BA, Brazil.
Int J Nephrol. 2013;2013:406165. doi: 10.1155/2013/406165. Epub 2013 Aug 19.
Introduction. The RIFLE classification defines three severity criteria for acute kidney injury (AKI): risk, injury, and failure. It was associated with mortality according to the gradation of AKI severity. However, it is not known if the APACHE II score, associated with the RIFLE classification, results in greater discriminatory power in relation to mortality in critical patients. Objective. To analyze whether the RIFLE classification adds value to the performance of APACHE II in predicting mortality in critically ill patients. Methods. An observational prospective cohort of 200 patients admitted to the ICU from July 2010 to July 2011. Results. The age of the sample was 66 (±16.7) years, 53.3% female. ICU mortality was 23.5%. The severity of AKI presented higher risk of death: class risk (RR = 1.89 CI:0.97-3.38, P = 0.001), grade injury (RR = 3.7 CI:1.71-8.08, P = 0.001), and class failure (RR = 4.79 CI:2.10-10.6, P = 0.001). The APACHE II had C-statistics of 0.75, 95% (CI:0.68-0.80, P = 0.001) and 0.80 (95% CI:0.74 to 0.86, P = 0.001) after being incorporated into the RIFLE classification in relation to prediction of death. In the comparison between AUROCs, P = 0.03. Conclusion. The severity of AKI, defined by the RIFLE classification, was a risk marker for mortality in critically ill patients, and improved the performance of APACHE II in predicting the mortality in this population.
引言。RIFLE分类法定义了急性肾损伤（AKI）的三个严重程度标准：风险、损伤和衰竭。它与AKI严重程度的分级相关的死亡率有关。然而，与RIFLE分类法相关的急性生理与慢性健康状况评分系统（APACHE II）在危重症患者死亡率方面是否具有更大的鉴别能力尚不清楚。目的。分析RIFLE分类法在预测危重症患者死亡率方面是否能提升APACHE II的性能。方法。对2010年7月至2011年7月入住重症监护病房（ICU）的200例患者进行前瞻性观察队列研究。结果。样本年龄为66（±16.7）岁，女性占53.3%。ICU死亡率为23.5%。AKI的严重程度呈现出更高的死亡风险：风险等级（相对危险度RR = 1.89，可信区间CI：0.97 - 3.38，P = 0.001）、损伤等级（RR = 3.7，CI：1.71 - 8.08，P = 0.001）和衰竭等级（RR = 4.79，CI：2.10 - 10.6，P = 0.001）。在纳入RIFLE分类法后，APACHE II在预测死亡方面的C统计量为0.75，95%可信区间（CI：0.68 - 0.80，P = 0.001）和0.80（95% CI：0.74至0.86，P = 0.001）。在受试者工作特征曲线下面积（AUROCs）的比较中，P = 0.03。结论。由RIFLE分类法定义的AKI严重程度是危重症患者死亡率的一个风险标志物，并提高了APACHE II在预测该人群死亡率方面的性能。
