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.     

重症监护病房患者急性肾损伤KDIGO与AKIN两种标准的应用比较

急性肾损伤(acute kidney injury,AKI)是指肾功能短时间迅速下降的一种临床危重症,在重症监护病房高发.它不仅是住院和死亡的独立危险因素[1],还与后续心血管疾病、慢性肾脏病及远期死亡等不良事件有关[2].目前估计,全球的ICU人群AKI发生率大约为50％[3].AKI已经成为增加社会和医疗负担的重要...     

中度重症急性胰腺炎和重症急性胰腺炎患者急性肾损伤预测模型的构建与验证研究

目的 构建并验证中度重症急性胰腺炎(MSAP)和重症急性胰腺炎(SAP)患者并发急性肾损伤(AKI)风险的预测模型。方法 将2019年1月至2022年8月海南医学院第一附属医院收治的确诊为MSAP和SAP的患者纳入本次回顾性研究,按照2∶1的比例将患者随机分为训练组和验证组。使用最小绝对收缩和选择算子(LASSO)法和机器学习筛选发生AKI的相关预测因子,用多因素Logistic回归分析筛选发生AKI的危险因素,并构建列线图预测模型,用校准曲线对模型进行一致性评价,用受试者工作特征(ROC)曲线评估模型的预测性能,用决策曲线分析(DCA)评估模型的临床价值。结果 共纳入565例MSAP和SAP患者,其中377例纳入训练组,188例纳入验证组,训练组中96例患者(25.46%)和验证组中44例患者(23.40%)并发AKI。各因素Logistic回归分析显示C反应蛋白、腹内压和胱抑素C是MSAP和SAP并发AKI的危险因素(P<0.05)。校准曲线显示模型的预测值与实际值一致性良好;受试者工作特征曲线显示模型预测性能较高,DCA显示模型的临床价值较高。结论 列线图模型在预测MSAP...     

血清半胱氨酸蛋白酶抑制剂C在重症患者急性肾损伤诊断中．的临床价值

目的探讨血清半胱氨酸蛋白酶抑制剂C（cystain C）在重症患者急性肾损伤（AKI）诊断中的临床价值。方法回顾性分析94例重症患者资料,分为AKI组和为无AKI组。每天采集血标本,应用苦味酸法检测血清肌酐（serum creatinine,Scr）水平,颗粒增强透射免疫比浊检测血清cystainC水平。探讨二者变化的相关性,并比较二者在AKI诊断上的时间中位值。结果 31例患者发生AKI,63例患者未发生AKI。31例AKI组患者血清Scr和cystainC值[分别为（208.8±101.3）μmol/L、（2.71±0.90）g/L]较63例无AKI组[分别为（79.7±9.11）μmol/L、（0.81±0.12）g/L]显著升高（P〈0.01）,两者变化一致,并呈显著正相关（r=0.813,P〈0.01）。cystainC各期诊断时间中位值（3,6,10d）较Scr提前（分别为5,7,11d）（P〈0.05）。结论 cystain C可作为AKI的诊断指标之一,AKI发生过程中cystainC升高较Scr早,因此在重症患者并发AKI的早期评估中具有一定的临床价值。     

血清胱抑素C在老年性急性肾损伤患者中早期诊断价值的研究

目的探讨血清胱抑素C(CysC)对老年性急性肾损伤(AKI)患者早期肾功能的评估价值。方法选取年龄大于或等于65岁,由门诊入院的41例符合2012年3月改善全球肾脏病预后组织(KIDIGO)发布的AKI诊断标准的老年患者(观察组)及68例健康体检者(对照组),采用酶法检测血清肌酐(Scr)水平,散射比浊法测定CysC水平,采用受试者工作特征曲线(ROC曲线)评价CysC对老年性AKI早期的诊断价值,应用Cockroft-Gault公式估算肾小球滤过率。结果观察组CysC水平较对照组明显升高(P0.05);观察组CysC与Scr呈明显线性相关(r=0.798,P0.05);CysC与肾小球滤过率呈负相关(r=-0.724,P0.05);ROC曲线分析得出CysC在老年性AKI的最佳截断值为1.67mg/L,Scr的最佳截断值为130.50μmol/L,诊断老年性AKI患者CysC的灵敏度明显高于Scr的灵敏度(P0.05)。在老年性AKI 1期和2期,CysC的灵敏度明显高于Scr(P0.05)。而在AKI 3期,两者的灵敏度差异无统计学意义(P0.05)。结论 CysC可作为老年性AKI患者肾小球滤过率的内源性标志物,对老年性AKI早期诊断具有重要价值。     

A comparison of different diagnostic criteria of acute kidney injury in critically ill patients

Introduction

Recently, the Kidney Disease: Improving Global Outcomes (KDIGO) proposed a new definition and classification of acute kidney injury (AKI) on the basis of the RIFLE (Risk, Injury, Failure, Loss of kidney function, and End-stage renal failure) and AKIN (Acute Kidney Injury Network) criteria, but comparisons of the three criteria in critically ill patients are rare.

Methods

We prospectively analyzed a clinical database of 3,107 adult patients who were consecutively admitted to one of 30 intensive care units of 28 tertiary hospitals in Beijing from 1 March to 31 August 2012. AKI was defined by the RIFLE, AKIN, and KDIGO criteria. Receiver operating curves were used to compare the predictive ability for mortality, and logistic regression analysis was used for the calculation of odds ratios and 95% confidence intervals.

Results

The rates of incidence of AKI using the RIFLE, AKIN, and KDIGO criteria were 46.9%, 38.4%, and 51%, respectively. KDIGO identified more patients than did RIFLE (51% versus 46.9%, P = 0.001) and AKIN (51% versus 38.4%, P <0.001). Compared with patients without AKI, in-hospital mortality was significantly higher for those diagnosed as AKI by using the RIFLE (27.8% versus 7%, P <0.001), AKIN (32.2% versus 7.1%, P <0.001), and KDIGO (27.4% versus 5.6%, P <0.001) criteria, respectively. There was no difference in AKI-related mortality between RIFLE and KDIGO (27.8% versus 27.4%, P = 0.815), but there was significant difference between AKIN and KDIGO (32.2% versus 27.4%, P = 0.006). The areas under the receiver operator characteristic curve for in-hospital mortality were 0.738 (P <0.001) for RIFLE, 0.746 (P <0.001) for AKIN, and 0.757 (P <0.001) for KDIGO. KDIGO was more predictive than RIFLE for in-hospital mortality (P <0.001), but there was no difference between KDIGO and AKIN (P = 0.12).

Conclusions

A higher incidence of AKI was diagnosed according to KDIGO criteria. Patients diagnosed as AKI had a significantly higher in-hospital mortality than non-AKI patients, no matter which criteria were used. Compared with the RIFLE criteria, KDIGO was more predictive for in-hospital mortality, but there was no significant difference between AKIN and KDIGO.     

急性肾损伤的RIFLE标准在危重病患者中的临床应用

目的 使用急性肾损伤(AKI)RIFLE分级标准评估危蓖患者AKI的发生率和住院病死率.方法 回顾性分析2004-07-01～2006-12-31入住ICU的739例患者资料,包括患者性别、年龄、基础疾病、APACHEⅡ评分等,并按照RIFLE分级标准将患者分为四组:即肾功能正常组、RIFLE-R组、RIFLE-I组和RIFLE-F组,比较四组患者的APACHEⅡ评分、住院病死率及ICU入住时间.结果 AKI在ICU患者的发生率是15.2%,R、I、F级发生率分别是6.2%、4.2%、4.7%,其中R级患者60例中14例(23.3%)发展为I级或F级,I级患者39例中8例(20.5%)发展为F级.住院期间达最大RIFLE分级R、I、F级的患者病死率分别是45.7%、64.5%、62.9%,而没有发生AKI的患者病死率是19.3%,RIFLE分级越高,APACHEⅡ评分越高,ICU入住时间越长.结论 RIFLE分级R级患者有着进展为I或F级的高危险性.与未发生AKI的患者比较,AKI患者有着更高的APACHE Ⅱ评分,更长的住院时间和更高的住院病死率.     

A comparison of RIFLE with and without urine output criteria for acute kidney injury in critically ill patients

Introduction

The Risk, Injury, Failure, Loss, and End-Stage Renal Disease (RIFLE) is a consensus-based classification system for diagnosing acute kidney insufficiency (AKI), based on serum creatinine (SCr) and urine output criteria (RIFLE_SCr+UO). The urine output criteria, however, are frequently discarded and many studies in the literature applied only the SCr criteria (RIFLE_SCr). We diagnosed AKI using both RIFLE methods and compared the effects on time to AKI diagnosis, AKI incidence and AKI severity.

Methods

This was a prospective observational cohort study during four months in adult critically ill patients admitted to the ICU for at least 48 hours. During the first week patients were scored daily for AKI according to RIFLE_SCr+UO and RIFLE_SCr. We assessed urine output hourly and fluid balance daily. The baseline SCr was estimated if a recent pre-ICU admission SCr was unknown. Based on the two RIFLE methods for each patient we determined time to AKI diagnosis (AKI-0) and maximum RIFLE grade.

Results

We studied 260 patients. A pre-ICU admission SCr was available in 101 (39%) patients. The two RIFLE methods resulted in statistically significantly different outcomes for incidence of AKI, diagnosis of AKI for individual patients, distribution of AKI-0 and distribution of the maximum RIFLE grade. Discarding the RIFLE urine criteria for AKI diagnosis significantly underestimated the presence and grade of AKI on admission and during the first ICU week (P < 0,001) and significantly delayed the diagnosis of AKI (P < 0.001). Based on RIFLE_SCr 45 patients had no AKI on admission but subsequently developed AKI. In 24 of these patients (53%) AKI would have been diagnosed at least one day earlier if the RIFLE urine criteria had been applied. Mortality rate in the AKI population was 38% based on RIFLE_SCr and 24% based on RIFLE_SCr+UO (P = 0.02).

Conclusions

The use of RIFLE without the urine criteria significantly underscores the incidence and grade of AKI, significantly delays the diagnosis of AKI and is associated with higher mortality.     

Early diagnosis of acute kidney injury in critically ill patients

Acute kidney injury (AKI) is a common and serious problem in critically ill patients. Tests currently used to detect AKI (i.e., serum creatinine, serum urea and various urinary indices) often result in delayed detection of injury--becoming abnormal at 48-72 h after the initial insult. This delayed detection translates into a potential missed opportunity for therapeutic interventions at a time when kidney damage may be limitable or reversible. This may also, in particular, account for the poor clinical outcomes commonly associated with AKI. The development of novel serum and urinary biomarkers capable of detecting AKI at an earlier phase of illness is therefore vital. This article will review the pitfalls of current conventional testing in kidney injury and discuss the emergence of novel biomarkers with the potential to revolutionize the field of critical care nephrology.     

RIFLE criteria for acute kidney injury are associated with hospital mortality in critically ill patients: a cohort analysis

Introduction  

The lack of a standard definition for acute kidney injury has resulted in a large variation in the reported incidence and associated mortality. RIFLE, a newly developed international consensus classification for acute kidney injury, defines three grades of severity – risk (class R), injury (class I) and failure (class F) – but has not yet been evaluated in a clinical series.     

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...     

Timing of renal replacement therapy in critically ill patients with acute kidney injury

PURPOSE OF REVIEW: Timing of renal replacement therapy in critically ill patients with acute kidney injury is highly subjective, and may influence outcome. We discuss renal and nonrenal criteria for timing considering the recent literature. RECENT FINDINGS: Two randomized and four nonrandomized controlled trials investigated the effects of timing on patient outcome. All but one randomized controlled trial indicated better outcome with early renal replacement therapy but had poor methodological quality. The heterogeneity of timing definition, study population and mode of therapy, however, hampered comparison among studies. SUMMARY: In the absence of large randomized controlled trials we can make no firm recommendations for timing of renal replacement therapy in acute kidney injury. Since rapid recovery of renal function is unlikely when other organ failure persists and the consequences of acute kidney injury may be more severe in critically ill patients, we suggest other organ failure is also considered. Patients with acute kidney injury, persisting shock and poorly recovering functions of other organs may benefit from early therapy. For future studies, we recommend describing renal replacement therapy timing according to the 'RIFLE' classification, as modified by the Acute Kidney Injury Network, and quantifying the severity of other organ failure. Biomarkers may refine acute kidney injury and timing definitions in the future.