RIFLE、AKIN和KDIGO急性肾损伤诊断标准在肺移植术后的应用比较

目的 比较风险、损伤、衰竭、失功能、终末期肾病(risk,injury,failure,loss,end stagerenal disease,RIFLE)、急性肾损伤网络(acute kidney injury network,AKIN)和改善全球肾脏病预后组织(kidney disease: improving g...

Post-operative acute kidney injury in lung transplant patients:comparing the diagnostic criteria of RIFLE,AKIN and KDIGO

Objective The aim of this study was to compare the differences of three diagnostic criteria,RIFLE(risk,injury,failure,loss,end stage renal disease),AKIN(acute kidney injury network),and KDIGO(kidney disease:improving global outcomes),in the assessment of post-operative acute renal kidney injury(AKI)in lung transplant recipients.Methods A total of 101 lung transplant patients treated in China-Japan Friendship Hospital from April 2017 to April 2019 were retrospectively analyzed.Their diagnosis and stage of AKI were conducted using RIFLE,AKIN and KDIGO criteria.The differences in ICU stay days,mechanical ventilation days,extracorporeal membrane oxygenation(ECMO)support days and hospitalization days were compared among the patients with different AKI stages.Receiver operating characteristic curve(ROC)curve was used to compare the accuracy of the 3 criteria in the prediction of one-year mortality.Results The incidence rates of post-operative AKI based on RIFLE,AKIN and KDIGO criteria were 73.2%,71.6%and 75.3%respectively.There were no statistical differences in ICU stay days(P=0.586,0.343 and 0.612,respectively),mechanical ventilation days(P=0.358,0.251 and 0.566,respectively),ECMO support days(P=0.450,0.888 and 0.605,respectively),and hospitalization days(P=0.878,0.902 and 0.765,respectively)among the patients with different stages classified by the three AKI diagnostic criteria.The area under the curves(AUCs)of ROC for RIFLE,AKIN and KDIGO to predict one-year mortality after lung transplant were 0.744,0.710 and 0.765 respectively,in which the AUCs of ROC for AKIN and KDIGO were statistically different(Z=2.009,P=0.044).Conclusions The incidence of AKI after lung transplant varies using the three diagnostic criteria.This study found that KDIGO criterion identified more AKI patients,and had better ability to predict postoperative one-year mortality.