RIFLE criteria for acute kidney injury in aortic arch surgery

Arnaoutakis, George J.; Bïhorac, Azra; Martin, Tomas D.; Hess, Philip J.; Klodell, Charles T.; Ejaz, A. Ahsan; Garvan, Cynthia; Tribble, Curtis G.; Beaver, Thomas M.

doi:10.1016/j.jtcvs.2007.08.039

Cited by 144 publications

(134 citation statements)

References 30 publications

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“…Recent studies have reported a higher prevalence of RIFLE-defined AKI in cardiothoracic surgery patients and confirmed the association of AKI with short-term mortality. [7][8][9] The few studies focused on long-term survival after AKI have been limited by heterogeneous cohorts of patients and have often included patients with preexisting chronic kidney disease (CKD). In addition, most of these studies included only severe AKI and lacked an adequate control group.…”

Section: Clinical Perspective On P 2453mentioning

confidence: 99%

Acute Kidney Injury Is Associated With Increased Long-Term Mortality After Cardiothoracic Surgery

et al. 2009

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Background-Long-term survival after acute kidney injury (AKI) is poorly studied. We report the relationship between long-term mortality and AKI with small changes in serum creatinine during hospitalization after various cardiothoracic surgery procedures. Methods and Results-This was a retrospective study of 2973 patients with no history of chronic kidney disease who were discharged from the hospital after cardiothoracic surgery between 1992 and 2002. AKI was defined by the RIFLE classification (Risk, Injury, Failure, Loss, and End stage), which requires at least a 50% increase in serum creatinine and stratifies patients into 3 grades of AKI: Risk, injury, and failure. Patient survival was determined through the National Social Security Death Index. Long-term survival was analyzed with a risk-adjusted Cox proportional hazards regression model. Survival was worse among patients with AKI and was proportional to its severity, with an adjusted hazard ratio of 1.23 (95% CI 1.06 to 1.42) for the least severe RIFLE risk class and 2.14 (95% CI 1.73 to 2.66) for the RIFLE failure class compared with patients without AKI. Survival was worse among all subgroups of cardiothoracic surgery with AKI except for valve surgery. Patients with complete renal recovery after AKI still had an increased adjusted hazard ratio for death of 1.28 (95% CI 1.11 to 1.48) compared with patients without AKI. Conclusions-The

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Section: Clinical Perspective On P 2453mentioning

confidence: 99%

Acute Kidney Injury Is Associated With Increased Long-Term Mortality After Cardiothoracic Surgery

et al. 2009

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“…Mishra et al reported that both serum and urine NGAL at 2 hours after cardiopulmonary bypass correlated with AKI as defined by a 50% increase in serum creatinine over baseline. 5 In our study, elevated serum NGAL was not predictive of AKI, by either RIFLE (50% increase in serum creatinine over baseline within 7 days) 3 or AKIN (creatinine rise greater than or equal to 0.3 mg/dL within 48 hours) 4 criteria, likely due to the small sample size and our inclusion criteria of "high-risk" cardiovascular surgery patients, the majority of whom had small elevations in serum creatinine.…”

Section: Discussionmentioning

confidence: 51%

“…1,2 Of patients undergoing "high risk" aortic arch surgery, 8% percent of patients may need dialysis. 3 Operative mortality in patients with AKI requiring dialysis is as high as 64%. 1 Multiple classification systems exist to stratify degrees of acute kidney injury.…”

Section: Introductionmentioning

confidence: 99%

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Early blood biomarkers predict organ injury and resource utilization following complex cardiac surgery

Kim

Arnaoutakis

Martin

et al. 2008

Journal of the American College of Surgeons

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Background-Patients undergoing complex cardiac surgery (thoracic aorta and valve) are at risk for organ failure and increased resource utilization. Neutrophil gelatinase-associated lipocalin (NGAL) has been found to be an early biomarker for renal injury. Multiplex cytokine immunoassays allow the evaluation of the early inflammatory response. We examined the relationship between early biomarker appearance (NGAL and multiplex cytokines) and organ injury and resource utilization.

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“…40,41 In cardiac and aortic arch surgery, a strong association between RIFLE classification and mortality has been consistently demonstrated. [42][43][44] The IAASSG supports adopting the RIFLE classification as a measure of postoperative kidney dysfunction (Table 5). This will capture subtle changes in renal function, which may have a significant impact on risk for subsequent mortality.…”

Section: Renal Systemmentioning

confidence: 92%

Standardizing Clinical End Points in Aortic Arch Surgery

et al. 2014

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1610S ince the introduction of hypothermic circulatory arrest for aortic arch surgery in 1975, 1 there has been considerable progress in addressing this complex surgical pathology. [2][3][4] However, the rapidity with which operative techniques have evolved has outpaced methodical appraisal of their clinical merit, leaving behind a wealth of perfunctory data. In particular, existing emphasis on neurological outcomes has neglected other critical end points, whereas inconsistent definitions and reporting formats limit the applicability of the results of some studies. Robust comparisons between institutional reports are therefore difficult, restricting critical appraisal and summary of existing surgical approaches.The International Aortic Arch Surgery Study Group (IAASSG) has been formed to enable multi-institutional collaboration to better explore the impact of surgical techniques on patient outcomes, using uniform definitions of events and clinical end points. A key endeavor is to standardize reporting formats to facilitate effective comparisons. Such a concerted effort, with the combined expertise of leading academic surgeons, paves the way for a unified language specific for aortic arch surgery that promotes closer cooperation and systematic evaluation and is essential in forming a framework of existing knowledge and guiding progress and research for the future. 5,6The IAASSG has devised a management-orientated classification system for significant clinical end points specific for aortic arch surgery and has undertaken a consensus survey of leading arch surgeons. The following report describes this classification scheme and reports the results of the consensus. Methodology Rationales of the Grading SystemA management-oriented classification system for complications, which grades adverse events by severity on the basis of the management required, is simple, reproducible, and comprehensive.7 It avoids duplication of overlapping results and limits the fluctuating ratings of negative outcomes between institutions by providing standardized definitions. 7,8 Stratifying the severity of relevant complications into grades allows more thorough analysis to be achieved to assist benchmarking of existing procedures, identifying areas in need of improvement, guiding prospective research, and evaluating the effectiveness of interventions. Such an approach has been used widely 7 and has been successfully validated by several subspecialties and procedures. [9][10][11][12][13][14] Variants of this approach have also been implemented for thoracic surgery, resulting in a feasible system that facilitates objective assessments and identifies the burden of individual complications. 15,16 Following the work by Dindo and coworkers, 7 we propose the following system for grading adverse outcomes specific for aortic arch surgery (Table 1). Clinical complications are stratified into 5 major grades, from those that are self-limiting or

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RIFLE criteria for acute kidney injury in aortic arch surgery

Abstract: Acute kidney injury as defined according to the RIFLE classification is a risk factor for mortality and will be useful in future studies of renal dysfunction in thoracic aortic surgery.

Cited by 144 publications

References 30 publications

Acute Kidney Injury Is Associated With Increased Long-Term Mortality After Cardiothoracic Surgery

Acute Kidney Injury Is Associated With Increased Long-Term Mortality After Cardiothoracic Surgery

Early blood biomarkers predict organ injury and resource utilization following complex cardiac surgery

Standardizing Clinical End Points in Aortic Arch Surgery

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