Bang J-Y, Lee J B, Yoon Y, Seo H-S, Song J-G, Hwang G S
Department of Anaesthesiology and Pain Medicine, Laboratory for Cardiovascular Dynamics, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Pungnap 2-dong, Songpa-gu, Seoul 138-736, Republic of Korea.
Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Pungnap 2-dong, Songpa-gu, Seoul 138-736, Republic of Korea.
Br J Anaesth. 2014 Dec;113(6):993-1000. doi: 10.1093/bja/aeu320. Epub 2014 Sep 25.
Although both Acute Kidney Injury Network (AKIN) and risk, injury, failure, loss, and end-stage (RIFLE) kidney disease criteria are frequently used to diagnose acute kidney injury (AKI), they have rarely been compared in the diagnosis of AKI in patients undergoing surgery for infrarenal abdominal aortic aneurysm (AAA). This study investigated the incidence of, and risk factors for, AKI, defined by AKIN and RIFLE criteria, and compared their ability to predict mortality after infrarenal AAA surgery.
This study examined 444 patients who underwent infrarenal AAA surgery between January 1999 and December 2011. Risk factors for AKI were assessed by multivariable analyses, and the impact of AKI on overall mortality was assessed by a Cox's proportional hazard model with inverse probability of treatment weighting (IPTW). Net reclassification improvement (NRI) was used to assess the performance of AKIN and RIFLE criteria in predicting overall mortality.
AKI based on AKIN and RIFLE criteria occurred in 82 (18.5%) and 55 (12.4%) patients, respectively. The independent risk factors for AKI were intraoperative red blood cell (RBC) transfusion and chronic kidney disease (CKD) by AKIN criteria, and age, intraoperative RBC transfusion, preoperative atrial fibrillation, and CKD by RIFLE criteria. After IPTW adjustment, AKI was related to 30 day mortality and overall mortality. NRI was 15.2% greater (P=0.04) for AKIN than for RIFLE criteria in assessing the risk of overall mortality.
Although AKI defined by either AKIN or RIFLE criteria was associated with overall mortality, AKIN criteria showed better prediction of mortality in patients undergoing infrarenal AAA surgery.
尽管急性肾损伤网络（AKIN）标准和风险、损伤、衰竭、丧失及终末期（RIFLE）肾病标准都常用于诊断急性肾损伤（AKI），但在接受肾下腹主动脉瘤（AAA）手术的患者中，它们在AKI诊断方面的比较却很少见。本研究调查了依据AKIN和RIFLE标准定义的AKI的发生率及危险因素，并比较了它们预测肾下腹主动脉瘤手术后死亡率的能力。
本研究纳入了1999年1月至2011年12月期间接受肾下腹主动脉瘤手术的444例患者。通过多变量分析评估AKI的危险因素，并采用具有治疗权重逆概率（IPTW）的Cox比例风险模型评估AKI对总体死亡率的影响。采用净重新分类改善（NRI）评估AKIN和RIFLE标准在预测总体死亡率方面的性能。
分别有82例（18.5%）和55例（12.4%）患者符合AKIN和RIFLE标准定义的AKI。依据AKIN标准，AKI的独立危险因素为术中红细胞（RBC）输注和慢性肾脏病（CKD）；依据RIFLE标准，AKI的独立危险因素为年龄、术中RBC输注、术前心房颤动和CKD。经过IPTW调整后，AKI与30天死亡率和总体死亡率相关。在评估总体死亡风险方面，AKIN标准的NRI比RIFLE标准高15.2%（P=0.04）。
尽管依据AKIN或RIFLE标准定义的AKI均与总体死亡率相关，但AKIN标准在预测肾下腹主动脉瘤手术患者的死亡率方面表现更佳。
