RIFLE标准和AKIN标准诊断急性肾损伤的对比研究

Comparison between the RIFLE and the Acute Kidney Injury Network Classifications in Diagnosis of Acute Kidney Injury

目的用RIFLE标准和AKIN标准评估急性肾损伤(AKI)的发生率,并比较AKIN标准和RIFLE标准在预测入住ICU危重患者病死率方面的优缺点。方法回顾性分析2003年1月—2008年6月入住ICU的331例患者(终末肾衰竭进行肾脏替代治疗的不包括在内)的临床资料。结果 AKIN标准比RIFLE标准诊断了更多的AKI患者(50.5%vs.43.8%,P=0.049),分类中1期(RIFLE标准中的风险期)患者更多(21.1%vs.14.8%,P=0.004),但是在对2期(RIFLE标准中的损伤期)(10.3%vs.10.9%,P=0.668)和3期(RIFLE标准中的衰竭期)(19.0%vs.18.1%,P=0.712)患者的诊断方面两者没有差异。按RIFLE标准定义的AKI患者的病死率明显高于非AKI患者(42.5%vs.12.4%,P<0.001),按AKIN标准定义的AKI患者的病死率明显高于非AKI患者(40.7%vs.9.8%,P<0.001)。RIFLE标准和AKIN标准在预测住院患者病死率方面差异无统计学意义(P>0.05)。结论和RIFLE标准相比,AKIN标准可以提高AKI诊断的敏感性,但在预测住院危重患者的病死率方面两者无差别。

Objective We evaluated the incidence of acute kidney injury and compared the ability of the maximum RIFLE and of the maximum AKIN within intensive care unit hospitalization in predicting inhospital mortality of critically ill patients.Methods Patients admitted to the Department of Intensive Medicine of our hospital between January 2003 and June 2008 were retrospectively evaluated.Chronic kidney disease patients undergoing dialysis or renal transplant patients were excluded from the analysis.Results AKIN criteria allowed the identification of more patients as having acute kidney injury（50.5% versus 43.8%,P=0.049） and classified more patients with Stage 1（risk in RIFLE）（21.1% versus 14.8%,P=0.004）,but no differences were observed for Stage 2（injury in RIFLE）（10.3% versus 10.9%,P=0.668） and for Stage 3（failure in RIFLE）（19.0% versus 18.1%,P=0.712）.Mortality was significantly higher for acute kidney injury defined by any of the RIFLE criteria（42.5% versus 12.4%,P0.001） or of the AKIN criteria（40.7% versus 9.8%,P0.001）.There were no statistical differences between RIFLE criteria and AKIN criteria in mortality by the acute kidney injury definition/classification criteria（P0.05）.Conclusion Although AKIN criteria could improve the sensitivity of the acute kidney injury diagnosis,it does not seem to improve on the ability of the RIFLE criteria in predicting inhospital mortality of critically ill patients.