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Báo cáo y học: "Clinical accuracy of RIFLE and Acute Kidney Injury Network (AKIN) criteria for acute kidney injury in patients undergoing cardiac surgery"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care giúp cho các bạn có thêm kiến thức về ngành y học đề tài: Clinical accuracy of RIFLE and Acute Kidney Injury Network (AKIN) criteria for acute kidney injury in patients undergoing cardiac surgery. | Englberger et al. Critical Care 2011 15 R16 http ccforum.eom content 15 1 R16 KS CRITICAL CARE RESEARCH Open Access Clinical accuracy of RIFLE and Acute Kidney Injury Network AKIN criteria for acute kidney injury in patients undergoing cardiac surgery 1 12 3 1 1 Lars Englberger Rakesh M Suri Zhuo Li Edward T Casey Richard C Daly Joseph A Dearani Hartzell V Schaff 1 Abstract Introduction The RIFLE risk injury failure loss of kidney function and end-stage renal failure classification for acute kidney injury AKI was recently modified by the Acute Kidney Injury Network AKIN . The two definition systems differ in several aspects and it is not clearly determined which has the better clinical accuracy. Methods In a retrospective observational study we investigated 4 836 consecutive patients undergoing cardiac surgery with cardiopulmonary bypass from 2005 to 2007 at Mayo Clinic Rochester MN USA. AKI was defined by RIFLE and AKIN criteria. Results Significantly more patients were diagnosed as AKI by AKIN 26.3 than by RIFLE 18.9 criteria P 0.0001 . Both definitions showed excellent association to outcome variables with worse outcome by increased severity of AKI P 0.001 all variables . Mortality was increased with an odds ratio OR of 4.5 95 CI 3.6 to 5.6 for one class increase by RIFLE and an OR of 5.3 95 CI 4.3 to 6.6 for one stage increase by AKIN. The multivariate model showed lower predictive ability of RIFLE for mortality. Patients classified as AKI in one but not in the other definition set were predominantly staged in the lowest AKI severity class 9.6 of patients in AKIN stage 1 2.3 of patients in RIFLE class R . Potential misclassification of AKI is higher in AKIN which is related to moving the 48-hour diagnostic window applied in AKIN criteria only. The greatest disagreement between both definition sets could be detected in patients with initial postoperative decrease of serum creatinine. Conclusions Modification of RIFLE by staging of all patients with acute renal .