RIFLE与AKIN急性肾损伤诊断标准在心脏手术患者中的应用比较

目的 比较RIFLE与AKIN的急性肾损伤（AKI）诊断标准在心脏手术患者中的应用价值。方法 收集2004年1月至2007年6月接受心脏手术患者的病史资料，分别采用RIFLE和AKIN标准对心脏手术后AKI（发生于术后7 d内）进行诊断和分期，比较两种标准的诊断敏感性及预测患者院内死亡的精确性。结果 共有1 056例患者纳入研究。RIFLE与AKIN标准诊断的心脏手术后AKI发病率比较，差异无统计学意义（29.55% vs 31.06%，P>0.05）。RIFLE与AKIN标准诊断的AKI患者的住院病死率以及对应各期患者的住院病死率比较，差异均无统计学意义（P>0.05）。Logistic回归分析显示，根据RIFLE和AKIN分期标准评估对应各期AKI患者发生院内死亡的相对危险度均较为接近。RIFLE和AKIN的AKI分期标准预测患者院内死亡的ROC曲线下面积分别为0.856和0.865（均P<0.001）。结论 与RIFLE标准比较，AKIN标准在对心脏手术后AKI诊断的敏感性及患者院内死亡预测的精确性方面未显示出明显的优势。

Comparison of RIFLE and AKIN diagnosis criteria for acute kidney injury in patients undergoing cardiac surgery

Objective To compare the RIFLE and AKIN diagnosis criteria for acute kidney injury ( AKI) in patients undergoing cardiac surgery. Methods Patients undergoing cardiac surgery from January 2004 to June 2007 were retrospectively evaluated. RIFLE and AKIN criteria were employed for the diagnosis and staging of AKI which occurred 7 d after cardiac surgery. The diagnosis sensitivity and precision for prediction of hospital mortality were compared between these two criteria. Results One thousand and fifty-six patients were included in this study. There was no significant difference between the prevalence of AKI after cardiac surgery diagnosed by RIFLE criteria and that diagnosed by AKIN criteria (29.55% vs 31.06%, P>0.05). There was no significant difference between the total hospital mortality and the hospital mortality of each stage of AKI diagnosed by RIFLE criteria and those diagnosed by AKIN criteria ( P > 0. 05). Logistic regression analysis suggested that the relative risk of hospital mortality for AKI was similar between patients diagnosed by AKIN criteria and those diagnosed by RIFLE criteria. The area under the ROC curve for hospital mortality was 0. 856 for RIFLE and 0.865 for AKIN in all patients (P<0.001). Conclusion Compared to RIFLE criteria, AKIN criteria do not improve the sensitivity of diagnosis and predictive ability of hospital mortality of AKI after cardiac surgery.