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A comparison of RIFLE with and without urine output criteria for acute kidney injury in critically ill patients

INTRODUCTION: The Risk, Injury, Failure, Loss, and End-Stage Renal Disease (RIFLE) is a consensus-based classification system for diagnosing acute kidney insufficiency (AKI), based on serum creatinine (SCr) and urine output criteria (RIFLE(SCr+UO)). The urine output criteria, however, are frequently...

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Autores principales: Wlodzimirow, Kama A, Abu-Hanna, Ameen, Slabbekoorn, Mathilde, Chamuleau, Robert AFM, Schultz, Marcus J, Bouman, Catherine SC
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2012
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3682302/
https://www.ncbi.nlm.nih.gov/pubmed/23078781
http://dx.doi.org/10.1186/cc11808
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author Wlodzimirow, Kama A
Abu-Hanna, Ameen
Slabbekoorn, Mathilde
Chamuleau, Robert AFM
Schultz, Marcus J
Bouman, Catherine SC
author_facet Wlodzimirow, Kama A
Abu-Hanna, Ameen
Slabbekoorn, Mathilde
Chamuleau, Robert AFM
Schultz, Marcus J
Bouman, Catherine SC
author_sort Wlodzimirow, Kama A
collection PubMed
description INTRODUCTION: The Risk, Injury, Failure, Loss, and End-Stage Renal Disease (RIFLE) is a consensus-based classification system for diagnosing acute kidney insufficiency (AKI), based on serum creatinine (SCr) and urine output criteria (RIFLE(SCr+UO)). The urine output criteria, however, are frequently discarded and many studies in the literature applied only the SCr criteria (RIFLE(SCr)). We diagnosed AKI using both RIFLE methods and compared the effects on time to AKI diagnosis, AKI incidence and AKI severity. METHODS: This was a prospective observational cohort study during four months in adult critically ill patients admitted to the ICU for at least 48 hours. During the first week patients were scored daily for AKI according to RIFLE(SCr+UO )and RIFLE(SCr. )We assessed urine output hourly and fluid balance daily. The baseline SCr was estimated if a recent pre-ICU admission SCr was unknown. Based on the two RIFLE methods for each patient we determined time to AKI diagnosis (AKI-0) and maximum RIFLE grade. RESULTS: We studied 260 patients. A pre-ICU admission SCr was available in 101 (39%) patients. The two RIFLE methods resulted in statistically significantly different outcomes for incidence of AKI, diagnosis of AKI for individual patients, distribution of AKI-0 and distribution of the maximum RIFLE grade. Discarding the RIFLE urine criteria for AKI diagnosis significantly underestimated the presence and grade of AKI on admission and during the first ICU week (P < 0,001) and significantly delayed the diagnosis of AKI (P < 0.001). Based on RIFLE(SCr )45 patients had no AKI on admission but subsequently developed AKI. In 24 of these patients (53%) AKI would have been diagnosed at least one day earlier if the RIFLE urine criteria had been applied. Mortality rate in the AKI population was 38% based on RIFLE(SCr )and 24% based on RIFLE(SCr+UO )(P = 0.02). CONCLUSIONS: The use of RIFLE without the urine criteria significantly underscores the incidence and grade of AKI, significantly delays the diagnosis of AKI and is associated with higher mortality.
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spelling pubmed-36823022013-06-25 A comparison of RIFLE with and without urine output criteria for acute kidney injury in critically ill patients Wlodzimirow, Kama A Abu-Hanna, Ameen Slabbekoorn, Mathilde Chamuleau, Robert AFM Schultz, Marcus J Bouman, Catherine SC Crit Care Research INTRODUCTION: The Risk, Injury, Failure, Loss, and End-Stage Renal Disease (RIFLE) is a consensus-based classification system for diagnosing acute kidney insufficiency (AKI), based on serum creatinine (SCr) and urine output criteria (RIFLE(SCr+UO)). The urine output criteria, however, are frequently discarded and many studies in the literature applied only the SCr criteria (RIFLE(SCr)). We diagnosed AKI using both RIFLE methods and compared the effects on time to AKI diagnosis, AKI incidence and AKI severity. METHODS: This was a prospective observational cohort study during four months in adult critically ill patients admitted to the ICU for at least 48 hours. During the first week patients were scored daily for AKI according to RIFLE(SCr+UO )and RIFLE(SCr. )We assessed urine output hourly and fluid balance daily. The baseline SCr was estimated if a recent pre-ICU admission SCr was unknown. Based on the two RIFLE methods for each patient we determined time to AKI diagnosis (AKI-0) and maximum RIFLE grade. RESULTS: We studied 260 patients. A pre-ICU admission SCr was available in 101 (39%) patients. The two RIFLE methods resulted in statistically significantly different outcomes for incidence of AKI, diagnosis of AKI for individual patients, distribution of AKI-0 and distribution of the maximum RIFLE grade. Discarding the RIFLE urine criteria for AKI diagnosis significantly underestimated the presence and grade of AKI on admission and during the first ICU week (P < 0,001) and significantly delayed the diagnosis of AKI (P < 0.001). Based on RIFLE(SCr )45 patients had no AKI on admission but subsequently developed AKI. In 24 of these patients (53%) AKI would have been diagnosed at least one day earlier if the RIFLE urine criteria had been applied. Mortality rate in the AKI population was 38% based on RIFLE(SCr )and 24% based on RIFLE(SCr+UO )(P = 0.02). CONCLUSIONS: The use of RIFLE without the urine criteria significantly underscores the incidence and grade of AKI, significantly delays the diagnosis of AKI and is associated with higher mortality. BioMed Central 2012 2012-10-18 /pmc/articles/PMC3682302/ /pubmed/23078781 http://dx.doi.org/10.1186/cc11808 Text en Copyright ©2012 Wlodzimirow et al.; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research
Wlodzimirow, Kama A
Abu-Hanna, Ameen
Slabbekoorn, Mathilde
Chamuleau, Robert AFM
Schultz, Marcus J
Bouman, Catherine SC
A comparison of RIFLE with and without urine output criteria for acute kidney injury in critically ill patients
title A comparison of RIFLE with and without urine output criteria for acute kidney injury in critically ill patients
title_full A comparison of RIFLE with and without urine output criteria for acute kidney injury in critically ill patients
title_fullStr A comparison of RIFLE with and without urine output criteria for acute kidney injury in critically ill patients
title_full_unstemmed A comparison of RIFLE with and without urine output criteria for acute kidney injury in critically ill patients
title_short A comparison of RIFLE with and without urine output criteria for acute kidney injury in critically ill patients
title_sort comparison of rifle with and without urine output criteria for acute kidney injury in critically ill patients
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3682302/
https://www.ncbi.nlm.nih.gov/pubmed/23078781
http://dx.doi.org/10.1186/cc11808
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