Shacham Yacov, Leshem-Rubinow Eran, Ziv-Baran Tomer, Gal-Oz Amir, Steinvil Arie, Ben Assa Eyal, Keren Gad, Roth Arie, Arbel Yaron
Department of Cardiology, Tel-Aviv Sourasky Medical Center Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, 6 Weizman Street, 64239, Tel Aviv, Israel,
Int Urol Nephrol. 2014 Dec;46(12):2371-7. doi: 10.1007/s11255-014-0827-6. Epub 2014 Sep 9.
Acute kidney injury (AKI) is associated with adverse outcomes after acute ST elevation myocardial infarction (STEMI). The recently proposed AKI network (AKIN) suggested modifications to the consensus classification system for AKI known as the risk, injury, failure, loss, end-stage (RIFLE) criteria. The aim of the current study was to compare the incidence and mortality (early and late) of AKI diagnosed by RIFLE and AKIN criteria in the STEMI patients undergoing primary percutaneous intervention (PCI).
We retrospectively studied 1,033 consecutive STEMI patients undergoing primary PCI. Recruited patients were admitted between January 2008 and November 2012 to the cardiac intensive care unit with the diagnosis of acute STEMI. We compared the utilization of RIFLE and AKIN criteria for the diagnosis, classification, and prediction of mortality.
The AKIN criteria allowed the identification of more patients as having AKI (9.6 vs. 3.9 %, p < 0.001) and classified more patients with stage 1 (risk in RIFLE) (7.6 vs. 1.9 %, p < 0.001) compared with the RIFLE criteria. Mortality was higher in AKI population defined by either RIFLE (46.3 vs. 6.8 %, OR 11.9, 95 % CI 6.15-23.1; p < 0.001) or AKIN (29 vs. 6.1 %; OR 6.3, 95 % CI 3.8-10.4; p < 0.001) criteria. In a multivariable logistic regression model, AKI defined with both RIFLE and AKIN was an independent predictor of both 30-day and up to 5-year all-cause mortality. However, there was no significant statistical difference in the risk provided by these two scoring systems.
AKIN criteria are more sensitive in defining AKI compared with the RIFLE criteria in STEMI. However, no difference exists in the mortality risk provided by these two scoring systems.
急性肾损伤（AKI）与急性ST段抬高型心肌梗死（STEMI）后的不良预后相关。最近提出的急性肾损伤网络（AKIN）对急性肾损伤的共识分类系统提出了修改建议，该系统被称为风险、损伤、衰竭、丧失、终末期（RIFLE）标准。本研究的目的是比较在接受直接经皮冠状动脉介入治疗（PCI）的STEMI患者中，根据RIFLE和AKIN标准诊断的AKI的发生率和死亡率（早期和晚期）。
我们回顾性研究了1033例连续接受直接PCI的STEMI患者。入选患者于2008年1月至2012年11月入住心脏重症监护病房，诊断为急性STEMI。我们比较了RIFLE和AKIN标准在诊断、分类和预测死亡率方面的应用情况。
与RIFLE标准相比，AKIN标准能识别出更多患有AKI的患者（9.6%对3.9%，p<0.001），并将更多患者分类为1期（RIFLE中的风险期）（7.6%对1.9%，p<0.001）。无论是根据RIFLE标准（46.3%对6.8%，OR 11.9，95%CI 6.15 - 23.1；p<0.001）还是AKIN标准（29%对6.1%；OR 6.3，95%CI 3.8 - 10.4；p<0.001）定义的AKI人群，死亡率都更高。在多变量逻辑回归模型中，根据RIFLE和AKIN定义的AKI都是30天和长达5年全因死亡率的独立预测因素。然而，这两种评分系统提供的风险没有显著统计学差异。
在STEMI中，与RIFLE标准相比，AKIN标准在定义AKI方面更敏感。然而，这两种评分系统提供的死亡风险没有差异。
