Acute kidney injury in critically ill patients classified by AKIN versus RIFLE using the SAPS 3 database

Joannidis, Michael; Metnitz, Barbara; Bauer, Péter; Schusterschitz, Nicola; Moreno, Rui P.; Druml, Wilfred; Metnitz, Philipp

doi:10.1007/s00134-009-1530-4

Cited by 435 publications

(353 citation statements)

References 31 publications

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“…Second, in the present study, notes were not reviewed to check for the context of patients' clinical presentations, and fluid resuscitation was not employed. In addition, the information in regard to urine output and estimated baseline CK levels was not used; this was the reason for the choice of this system based on the AKIN criteria instead of another other system of classification of AKI, such as risk, injury, failure, loss, and end-stage kidney disease (RIFLE) [34,35]. The degree of AKI classified by both the RIFLE and AKIN criteria correlates with mortality in a progressive fashion, emphasizing the importance of the severity of AKI.…”

Section: Discussionmentioning

confidence: 99%

Acute kidney injury in critical ill patients affected by influenza A (H1N1) virus infection

et al. 2011

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IntroductionLittle information exists about the impact of acute kidney injury (AKI) in critically ill patients with the pandemic 2009 influenza A (H1N1) virus infection.MethodsWe conducted a prospective, observational, multicenter study in 148 Spanish intensive care units (ICUs). Patients with chronic renal failure were excluded. AKI was defined according to Acute Kidney Injury Network (AKIN) criteria.ResultsA total of 661 patients were analyzed. One hundred eighteen (17.7%) patients developed AKI; of these, 37 (31.4%) of the patients with AKI were classified as AKI I, 15 (12.7%) were classified as AKI II and 66 (55.9%) were classified as AKI III, among the latter of whom 50 (75.7%) required continuous renal replacement therapy. Patients with AKI had a higher Acute Physiology and Chronic Health Evaluation II score (19.2 ± 8.3 versus 12.6 ± 5.9; P < 0.001), a higher Sequential Organ Failure Assessment score (8.7 ± 4.2 versus 4.8 ± 2.9; P < 0.001), more need for mechanical ventilation (MV) (87.3% versus 56.2%; P < 0.01, odds ratio (OR) 5.3, 95% confidence interval (CI) 3.0 to 9.4), a greater incidence of shock (75.4% versus 38.3%; P < 0.01, OR 4.9, 95% CI, 3.1 to 7.7), a greater incidence of multiorgan dysfunction syndrome (92.4% versus 54.7%; P < 0.01, OR 10.0, 95% CI, 4.9 to 20.21) and a greater incidence of coinfection (23.7% versus 14.4%; P < 0.01, OR 1.8, 95% CI, 1.1 to 3.0). In survivors, patients with AKI remained on MV longer and ICU and hospital length of stay were longer than in patients without AKI. The overall mortality was 18.8% and was significantly higher for AKI patients (44.1% versus 13.3%; P < 0.01, OR 5.1, 95% CI, 3.3 to 7.9). Logistic regression analysis was performed with AKIN criteria, and it demonstrated that among patients with AKI, only AKI III was independently associated with higher ICU mortality (P < 0.001, OR 4.81, 95% CI 2.17 to 10.62).ConclusionsIn our cohort of patients with H1N1 virus infection, only those cases in the AKI III category were independently associated with mortality.

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Section: Discussionmentioning

confidence: 99%

Acute kidney injury in critical ill patients affected by influenza A (H1N1) virus infection

et al. 2011

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“…Nevertheless, even after ageadjustment of the back-estimation formulae, the results did not improve. Unfortunately, many investigations have used an estimation of bSCr in up to 50% of their patients (11)(12)(13)(14)(15)29,30). As we and others have found (6,11,24), the estimated bSCr is inadequate when precise case adjudication is required, for example, in defining mild AKI stages (25).…”

Section: Discussionmentioning

confidence: 98%

“…However, use of a standard GFR is not appropriate because there is high variability in the GFR within a given population due to age or gender. Although these methods for estimation of bSCr based on GFR have been used in several epidemiologic studies, they require further validation and improved methods for estimating bSCr are needed (11)(12)(13)(14)(15).…”

Section: Introductionmentioning

confidence: 99%

Serum Creatinine Back-Estimation in Cardiac Surgery Patients

Bernardi¹,

Schmidlin

Ristl

et al. 2016

Clinical Journal of the American Society of Nephrology

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Background and objectives A knowledge of baseline serum creatinine (bSCr) is mandatory for diagnosing and staging AKI. With often missing values, bSCr is estimated by back-calculation using several equations designed for the estimation of GFR, assuming a "true" GFR of 75 ml/min per 1.73 m 2 . Using a data set from a large cardiac surgery cohort, we tested the appropriateness of such an approach and compared estimated and measured bSCr. Moreover, we designed a novel data-driven model (estimated serum creatinine [eSCr]) for estimating bSCr. Finally, we analyzed the extent of AKI and mortality rate misclassifications.Design, setting, participants, & measurements Data for 8024 patients (2833 women) in our cardiac surgery center were included from 1997 to 2008. Measured and estimated bSCr were plotted against age for men and women. Patients were classified to AKI stages defined by the Kidney Disease Improving Global Outcomes (KDIGO) group. Results were compared with data from another cardiac surgery center in Zurich, Switzerland.Results The Modification of Diet in Renal Disease and the Chronic Kidney Disease Epidemiology Collaboration formulae describe higher estimated bSCr values in younger patients, but lower values in older patients compared with the measured bSCr values in both centers. The Pittsburgh Linear Three Variables formula correctly describes the increasing bSCr with age, however, it underestimates the overall bSCr level, being in the range of the 25% quantile of the measured values. Our eSCr model estimated measured bSCr best. AKI stage 1 classification using all formulae, including our eSCr model, was incorrect in 53%-80% of patients in Vienna and in 74%-91% in Zurich; AKI severity (according to KDIGO stages) and also mortality were overestimated. Mortality rate was higher among patients falsely classified into higher KDIGO stages by estimated bSCr.Conclusions bSCr values back-estimated using currently available eGFR formulae are inaccurate and cannot correctly classify AKI stages. Our model eSCr improves the prediction of AKI but to a still inadequate extent.

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“…Hence it would have been valuable to evaluate pRIFLE in comparison to AKIN staging criteria and their influence on outcome and risk factors for AKI. It is also known that both the criteria identify somewhat different patients, particularly in small children in whom small changes may have large effect on AKI classification [5]. In order to overcome the lack of baseline creatinine, it would have been interesting to use baseline creatinine estimated by formula or use of age and gender specific norms and compare it with measured baseline serum creatinine [6].…”

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confidence: 99%

Acute kidney injury in children: Look for it and don’t ignore it!

Vasudevan

Phadke

2012

Indian Pediatr

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Acute kidney injury in critically ill patients classified by AKIN versus RIFLE using the SAPS 3 database

Abstract: 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.

Cited by 435 publications

References 31 publications

Acute kidney injury in critical ill patients affected by influenza A (H1N1) virus infection

Acute kidney injury in critical ill patients affected by influenza A (H1N1) virus infection

Serum Creatinine Back-Estimation in Cardiac Surgery Patients

Acute kidney injury in children: Look for it and don’t ignore it!

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