Acute kidney injury in critically ill patients classified by AKIN versus RIFLE using the SAPS 3 database
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Acute kidney injury (AKI) is associated with significantly increased morbidity and mortality. To provide a uniformly accepted definition, the RIFLE classification was introduced by the Acute Dialysis Quality Initiative, recently modified by the Acute Kidney Injury Network (AKIN), suggesting staging of AKI based on dynamic changes within 48 h. This study compares these two classification systems with regard to outcome.
Cohort analysis of SAPS 3 database.
Sixteen thousand seven hundred and eighty-four ICU patients from 303 ICUs were analysed. Classification was performed according to RIFLE (Risk, Injury, Failure) or according to AKIN (stage 1, 2, 3) without including a requirement of renal replacement therapy in the analysis. Changes of serum creatinine as well as urinary output were assessed for both AKIN and RIFLE during the first 48 h of ICU admission. Primary endpoint was hospital mortality.
Incidence of AKI in our population of critically ill patients was found to range between 28.5 and 35.5% when applying AKIN and RIFLE criteria, respectively, associated with increased hospital mortality averaging 36.4%. Observed-to-expected mortality ratios revealed excess mortality conferred by any degree of AKI increasing from 0.81 for patients classified as non-AKI up to 1.31 and 1.23 with AKIN stage 3 or RIFLE Failure, respectively. AKIN misclassified 1,504 patients as non-AKI compared to RIFLE which misclassified 504 patients.
Acute kidney injury classified by either RIFLE or AKIN is associated with increased hospital mortality. Despite presumed increased sensitivity by the AKIN classification, RIFLE shows better robustness and a higher detection rate of AKI during the first 48 h of ICU admission.
KeywordsAcute kidney injury Epidemiology Incidence Outcome Urinary output Creatinine
This work was supported by the Oesterrreichische Nationalbank Jubilaeumsfondsprojekt Nr. 12690 (P. M.) and Nr. 12094 (M. J.).
Conflict of interest statement
- 3.Bellomo R, Ronco C, Kellum JA, Mehta RL, Palevsky P (2004) Acute renal failure—definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care 8:R204–R212PubMedCrossRefGoogle Scholar
- 16.Joannidis M, Jordan B, Bauer P, Druml W, Metnitz PG (2007) Comparison of RIFLE versus AKIN for classification of acute kidney injury. Intensive Care Med 33:S98 (Abstract)Google Scholar
- 17.Metnitz PG, Moreno RP, Almeida E, Jordan B, Bauer P, Campos RA, Iapichino G, Edbrooke D, Capuzzo M, Le G Jr (2005) SAPS 3—from evaluation of the patient to evaluation of the intensive care unit. Part 1: objectives, methods and cohort description. Intensive Care Med 31:1336–1344PubMedCrossRefGoogle Scholar
- 23.Bouman C, Kellum JA, Lameire N, Levin N (2003) Definition for acute renal failure. In: Acute dialysis quality initiative-2nd international consensus conference. http://www.adqi.net
- 30.Cruz DN, Bolgan I, Perazella MA, Bonello M, de CM, Corradi V, Polanco N, Ocampo C, Nalesso F, Piccinni P, Ronco C (2007) North East Italian Prospective Hospital Renal Outcome Survey on acute kidney injury (NEiPHROS-AKI): targeting the problem with the RIFLE criteria. Clin J Am Soc Nephrol 2:418–425PubMedCrossRefGoogle Scholar
- 32.Uchino S, Bellomo R, Morimatsu H, Morgera S, Schetz M, Tan I, Bouman C, Macedo E, Gibney N, Tolwani A, Oudemans-van SH, Ronco C, Kellum JA (2007) Continuous renal replacement therapy: a worldwide practice survey. The beginning and ending supportive therapy for the kidney (B.E.S.T. kidney) investigators. Intensive Care Med 33:1563–1570PubMedCrossRefGoogle Scholar
- 33.Palevsky PM, Zhang JH, O’Connor TZ, Chertow GM, Crowley ST, Choudhury D, Finkel K, Kellum JA, Paganini E, Schein RM, Smith MW, Swanson KM, Thompson BT, Vijayan A, Watnick S, Star RA, Peduzzi P (2008) Intensity of renal support in critically ill patients with acute kidney injury. N Engl J Med 359:7–20PubMedCrossRefGoogle Scholar