RIFLE、AKIN和KDIGO标准预测肝移植术后早期死亡的准确性比较

Comparison of the accuracy of RIFLE,AKIN and KDIGO criteria in predicting early death after liver transplantation

目的比较RIFLE、急性肾损伤网络(AKIN)和改善全球肾脏病预后组织(KDIGO)3个急性肾损伤(AKI)标准对肝移植受者术后早期(术后30 d)死亡的预测准确性。方法回顾性分析173例肝移植受者临床资料。根据RIFLE、AKIN和KDIGO 3个标准计算术后AKI发生率,分析术后30 d全因病死率及死因,应用二元Logistic回归分析术后30 d内死亡的危险因素,应用受试者工作特征(ROC)曲线比较3个标准对术后30 d内死亡的预测准确性。结果根据RIFLE、AKIN和KDIGO标准,术后AKI发生率分别为48.0%、51.4%和53.8%,术后30 d内死亡13例,病死率为7.5%。RIFLE、AKIN和KDIGO分期是术后30 d内死亡的独立危险因素(均为P<0.05)。RIFLE、AKIN和KDIGO分期预测肝移植术后30 d内死亡的曲线下面积(AUC)分别为0.828、0.766和0.844,AKIN与KDIGO比较,差异有统计学意义(P<0.05)。结论KDIGO标准对于肝移植受者术后早期死亡的预测能力更好。但作为工具,三者之间的比较选择尚需多中心大样本的证据支持。

Objective To compare the accuracy of three acute kidney injury(AKI)criteria of RIFLE,Acute Kidney Injury Network(AKIN)and Kidney Disease:Improving Global Outcomes(KDIGO)in predicting the early(30 d)postoperative death of liver transplant recipients.Methods Clinical data of 173 liver transplant recipients were retrospectively analyzed.The incidence of postoperative AKI was calculated according to the three criteria of RIFLE,AKIN and KDIGO.The all-cause fatality rate and cause of death at postoperative 30 d were analyzed.The risk factors of death within 30 d after operation were analyzed by binary Logistic regression.The prediction accuracy of three criteria for death within 30 d after operation was compared by the receiver operating characteristic(ROC)curve.Results According to the RIFLE,AKIN and KDIGO criteria,the incidences of postoperative AKI were 48.0%,51.4%and 53.8%,respectively.Thirteen patients died within 30 d after operation and the fatality rate was 7.5%.RIFLE,AKIN and KDIGO stages were the independent risk factors for death within 30 d after operation(all P<0.05).The area under the curve(AUC)of RIFLE,AKIN and KDIGO stages to predict death within 30 d after liver transplantation were 0.828,0.766 and 0.844,respectively.There was a statistically significant difference between AKIN and KDIGO(P<0.05).Conclusions KDIGO criterion is better for predicting early death after liver transplantation.However,as a tool,the comparative selection among these three criteria still needs the evidence support from a large multicenter sample.