RIFLE和AKIN标准在评价住院急性肾损伤患者病死率及其相关危险因素中的应用

RIFLE and AKIN criteria for mortality and risk factors of acute kidney injury in hospitalized patients

目的:应用风险期、损伤期、衰竭期、丧失期、终末期肾病(risk,injury,failure,loss,end stage kidney disease,RIFLE)和急性肾损伤网络(acute kidney injury network,AKIN)两种标准评价住院急性肾损伤(acute kidney injury,AKI)患者的病死率及其相关危险因素。方法:分析2006年2月至2011年1月中南大学湘雅二医院各临床科室收治的AKI患者的临床资料,分别采用RIFLE和AKIN标准对已诊断为AKI的病例重新确认AKI诊断并分级,比较两种标准诊断的住院AKI各期患者临床特征、院内病死率及其相关危险因素;应用logistic回归分析筛选出影响AKI院内病死率的相关危险因素。结果:采用RIFLE标准诊断出1020例、AKIN标准诊断出1027例AKI患者。RIFLE和AKIN标准的所有AKI患者及其相对应各期患者的院内病死率、住院天数、完全恢复率两两比较,差异均未见统计学意义(P>0.05)。单因素方差分析显示,死亡组AKI患者的年龄、肾前性疾病、院内AKI、机械通气、低血压、多器官功能衰竭数目、急性肾小管坏死个体严重程度指数(ATN-ISS评分)、血清钾离子浓度与存活组患者比较均差异有统计学意义(P<0.05)。多因素logistic回归分析筛选出年龄≥65岁、院内AKI、低血压、多器官功能衰竭数目、ATN-ISS评分、血清钾离子浓度为影响AKI患者院内病死率的独立危险因素。结论:RIFLE和AKIN标准对住院AKI患者近期预后的评价具有相同科学价值,且AKI分级与住院AKI患者的预后有关。

Objective： To evaluate the mortality and risk factors for acute kidney injury （AKI） in hospitalized patients by the risk, injury, failure, loss, end stage kidney disease （RIFLE） and acute kidney injury network （AKIN）. Methods： We constructed a retrospective study of all AKI patients in the Second Xiangya Hospital of Central South University between February Z006 and January 2011. The diagnosis and classification of AKI were reconfirmed and categorized by RIFLE and AKIN criteria. To compare the clinical characteristics, mortality and associated risk factors in AKI patients by the RIFLE and AKIN stage, univariate analysis and multivariate logistic regression analysis were performed. Results： The patients were diagnosed as AKI by AKIN （n=1027） or by RIFLE criteria （n=1020）. There was no significant difference in the hospital mortality, hospital length stay （days）, or the proportion of complete recovery in each stage of AKI patients by RIFLE and AKIN （P〉0.05）. In the univariate analysis, age, pre-renal causes, proportion of hospital acquired AKI, mechanical ventilation, hypotension, the number of failed organs, acute tubular necrosis-index severity score （ATN-ISS）, and the peak of serum potassium ion concentration were significantly higher in the non-survivors than in the survivors （P〈0.05）. Logistic regression analysis revealed that age older than 65, hospital acquired AKI, hypotension, number of failed organs, ATN-ISS scores, and the peak of serum potassium ion concentration were independent risk factors for hospital mortality. Conclusion： Both RIFLE and AKIN criteria have similar scientific value in assessing hospital mortality. AKI stage is associated with the recent prognosis of AKI patients.