急性肾损伤RIFLE与AKIN标准在重症监护病房患者的应用比较

目的 比较急性肾损伤(AKI)RIFLE标准(危险、损伤、衰竭、肾功能丧失、终末期肾病)与急性肾损伤网络工作小组(AKIN)诊断标准在重症监护病房(ICU)成人患者中的应用价值.方法 收集广东省人民医院ICU2009年10月至2010年7月成人患者的病历资料.分别采用RIFLE标准与AKIN标准对ICU中AKI及其严重程度进行定义分期,比较两种标准诊断的敏感性及预测院内病死率的准确性.结果 共入选患者524例,其中符合RIFLE标准的AKI 95例,符合AKIN标准的AKI 135例,两种标准在判断ICU患者AKI的发生率方面差异有统计学意义(18.1％比25.8％,P＜0.05).AKI为院内死亡的独立危险因素;RIFLE标准预测患者院内死亡的受试者工作特征曲线(ROC曲线)下面积(AUC)为0.729 3,95％可信区间(95％CI)为0.600 5～0.858 1,P＜0.001;AKIN标准预测患者院内死亡的AUC为0.777 7,95 ％CI为0.666 4～0.889 0,P＜0.001;二者诊断AKI的预测能力比较差异无统计学意义(37.9％比34.1％,P＞0.05).结论 与RIFLE标准相比,AKIN标准在诊断ICU成人患者AKI的发生方面更敏感,但是在预测院内死亡方面并未体现优势.

The sensitivity and accuracy of RIFLE and AKIN criteria for acute kidney injury diagnosis in intensive care unit patients

Objective To evaluate the sensitivity/accuracy of 2 different acute kidney injury(AKI)diagnosis/classification criteria,the RIFLE(risk,injury,failure,loss of kidney function,end-stage kidney disease)and the acute kidney injury network(AKIN),for patients in intensive care unit(ICU).Methods Clinical data were collected from all adult patients admitted to the Department of Intensive Medicine in Guangdong General Hospital between October 2009 and July 2010,and AKI cases were identified/classified using RIFLE and AKIN criteria separately,for statistical evaluation of their diagnostic sensitivity,and accuracy in hospital mortality prediction.Results In all 524 patients evaluated,AKI were identified by RIFLE criteria in 95 of them,while by AKIN,135.The AKI incidence by RIFLE(18.1％),and AKIN (25.8％)were significantly different(P＜0.05).Meanwhile,AKI incidence was found independent from the mortality,either by RIFLE or AKIN(both P＜0.001).In all patients,the area under the receiver operator characteristic curve(ROC curve),the index for hospital mortality prediction,was 0.729 3 for RIFLE[with 95％ confidence interval(95％CI)ranging from 0.600 5 to 0.858 1,P＜0.001],and for AKIN,0.777 7 (95％CI:0.666 4-0.889 0,P＜0.001).No significant difference was found between the total hospital mortality by the two criteria(37.9％ vs.34.1％,P＞ 0.05).Conclusion Although AKIN criteria has higher sensitivity in AKI diagnosis,it is not different from the RIFLE criteria in predicting hospital mortality in critically ill patients.