Acute kidney injury in patients with severe sepsis or septic shock: a comparison between the ‘Risk, Injury, Failure, Loss of kidney function, End-stage kidney disease’ (RIFLE), Acute Kidney Injury Network (AKIN) and Kidney Disease: Improving Global Outcomes (KDIGO) classifications

Abstract

PurposeUsing the Risk, Injury, Failure, Loss of kidney function, End-stage kidney disease (RIFLE), Acute Kidney Injury Network (AKIN) and Kidney Disease: Improving Global Outcomes (KDIGO) systems, the incidence of acute kidney injury (AKI) and their ability to predict in-hospital mortality in severe sepsis or septic shock was compared.Materials and methodsWe performed a retrospective analysis of 457 critically ill patients with severe sepsis or septic shock hospitalized between January 2008 and December 2014. Multivariate logistic regression was employed to evaluate the association between the RIFLE, AKIN and KDIGO systems with in-hospital mortality. Model fit was assessed by the goodness-of-fit test and discrimination by the area under the receiver operating characteristic (AUROC) curve. Statistical significance was defined as P < 0.05.ResultsRIFLE (84.2%) and KDIGO (87.5%) identified more patients with AKI than AKIN (72.8%) (P < 0.001). AKI defined by AKIN and KDIGO was associated with in-hospital mortality {AKIN: adjusted odds ratio [OR] 2.3[95% confidence interval (CI) 1.3–4], P = 0.006; KDIGO: adjusted OR 2.7[95% CI 1.2–6.2], P = 0.021} while AKI defined by RIFLE was not [adjusted OR 2.0 (95% CI 1–4), P = 0.063]. The AUROC curve for in-hospital mortality was similar between the three classifications (RIFLE 0.652, P < 0.001; AKIN 0.686, P < 0.001; KDIGO 0.658, P < 0.001).ConclusionsRIFLE and KDIGO diagnosed more patients with AKI than AKIN, but the prediction ability for in-hospital mortality was similar between the three systems.

Serum Neutrophil Gelatinase-associated Lipocalin Measured at Admission to Predict Mortality in Sepsis-associated Acute Kidney Injury of Vietnamese Critically Ill Patients

“…There were about 75% of patients who suffered from stage 3 SA-AKI died while this proportion in stage 1 and stage 2 SA-AKI were about 20% and 30% respectively. Our results were similar to study of Peireira M et al in mortality rate of stage 1 and stage 2 SA-AKI, but our study had a higher proportion in mortality rate of stage 3 SA-AKI (75% compared with 48%) [22]. This might be caused by our limitation in sample size of this group.…”

Comparison between Rhabdomyolysis Induced and Septic Acute Kidney Injury in Central Nepal

“…Sepsis, which is a clinical condition characterized by organ dysfunction secondary to patient's dysregulated response to infection, is associated with AKI in up to 60-70% of patients, [38][39][40] and it is well understood that the patients with sepsis complicated by AKI have higher mortality than those without AKI. 41 Although the pathophysiology is poorly understood, the contributing factor for SA-AKI could be the renal hypotension associated with ischemia, inflammation and apoptosis.…”

New trends in the study of post-transplant acute kidney injury after liver transplantation

“…Критерии RIFLE и KDIGO идентифицируют больше случаев ОПП, чем критерии AKIN (RIFLE -84,2%, KDIGO -87,5%, AKIN -72,8%, p < 0,001), хотя прогнозирование внутрибольничной летальности было аналогично при применении этих трех классификаций. У септических пациентов ОПП, диагностированное только на основании снижения уровня диуреза, было лучшим предиктором госпитальной смертности, чем ОПП, определяемое либо уровнем креатинина сыворотки крови (SCr), либо SCr и объемом диуреза (р < 0,001), что свидетельствует о диагностической и прогностической значимости показателя диуреза при сепсисе у пациентов с ОПП [53]. Другие авторы также отмечали преимущество классификаций RIFLE и KDIGO в сравнении с классификацией AKIN при диагностике ОПП у тяжелых пациентов [1, 2, 54].…”