Prognostic Value of Rifle Criteria for Acute Kidney Injury in the Critically ill Patients

The aim of this study was to investigate the value of hematocrit (HCT) level in predicting the outcomes of critically ill patients with acute kidney injury (AKI). A retrospective study of a total of 14,350 intensive care unit (ICU) patients, who were selected from Beth Israel Deaconess Medical Center (Boston, MA, USA) and met the inclusion criteria, was carried out. And the patient data were extracted from the Multiparameter Intelligent Monitoring in Intensive Care Database III version 1.3 (MIMIC-III v1.3). In our study, HCT quintiles were used to categorize the subjects into groups. The clinical outcomes were 30- and 90-day mortality in the ICU. Cox proportional-hazards models were used to evaluate the association between the HCT and survival. A total of 2827 30-day deaths and 3828 90-day deaths occurred. In univariate analysis, low HCT was significantly associated with increased 30- and 90-day mortality among females, which, however, was not observed in multivariate analysis adjusted for age, ethnicity, dialysate, continuous renal replacement therapy (CRRT), use of insulin, use of ventilator, AKI stages, and report of obesity. In subgroup analysis, an inverse association between HCT levels and risk of mortality for 90-day outcome was observed for female patients by exclusion of dialysate use, receiving CRRT, and obesity reports. Therefore, these findings suggest that lower HCT was associated with an increased risk of mortality in critically ill patients with AKI, and the effect appears to be stronger among women than men. The prognostic value of HCT seems dependent on other factors, for example, dialysate use, CRRT, and obesity. Further multicenter study is in demand to confirm the validity of the results presented in this article.

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Impact of glycemic control on the incidence of acute kidney injury in critically ill patients: a comparison of two strategies using the RIFLE criteria

Clinics ◽

10.1590/s1807-59322010000800005 ◽

2010 ◽

Vol 65 (8) ◽

Cited By ~ 4

Author(s):

José Raimundo Araújo de Azevedo ◽

Renato Palácio de Azevedo ◽

Lara Carneiro de Lucena ◽

Nathalia de Nazaré Rabelo da Costa ◽

Widlane Sousa da Silva

Keyword(s):

Acute Kidney Injury ◽

Glycemic Control ◽

Critically Ill ◽

Critically Ill Patients ◽

Kidney Injury ◽

Rifle Criteria

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Acute Kidney Injury Associated with Combination Antimicrobial Therapy in the Medical Information Mart for Intensive Care (MIMIC) III Database

Open Forum Infectious Diseases ◽

10.1093/ofid/ofx163.821 ◽

2017 ◽

Vol 4 (suppl_1) ◽

pp. S344-S344

Author(s):

W Cliff Rutter ◽

David S Burgess

Keyword(s):

Acute Kidney Injury ◽

Logistic Regression ◽

Intensive Care ◽

Critically Ill ◽

Critically Ill Patients ◽

Hepatorenal Syndrome ◽

Medical Information ◽

Kidney Injury ◽

Rifle Criteria ◽

Multivariable Logistic Regression

Abstract Background Increased acute kidney injury (AKI) incidence is linked with coadministration of vancomycin (VAN) and piperacillin-tazobactam (TZP) in the general hospital population when compared with VAN and cefepime (FEP); however, this phenomenon was not found in critically ill patients. Methods Patients receiving VAN in combination with FEP or TZP for at least 48 hours during an intensive care unit stay were included in this retrospective review. AKI was defined with the Risk, Injury, Failure, Loss, and End-stage (RIFLE) criteria. Exposure to common nephrotoxins was captured within 24 hours of combination therapy initiation through the entire treatment window. Basic descriptive statistics were performed, along with bivariable and multivariable logistic regression models of AKI odds. Results In total, 2230 patients were included, with 773 receiving FEP+VAN and 1457 receiving TZP+VAN. The groups were well balanced at baseline in most covariates, with the exception of hepatorenal syndrome diagnosis (TZP+VAN 1.4% vs. FEP+VAN 0.3%, P = 0.02) and vasopressor exposure (TZP+VAN 26.2% vs 21.5%, P = 0.01) being more common in the TZP+VAN group. Patients in the FEP+VAN group had a higher underlying severity of disease (Charlson comorbidity index [CCI] 2.7 vs. 2.3, P =0.0002). AKI incidence was higher in the TZP+VAN cohort (35.1% vs. 26.5%, P = 0.00004), with each stratification of the RIFLE criteria being higher. The time until onset of AKI was similar between groups (TZP+VAN median 1 [0–3] days vs. FEP+VAN 1 [0–4] days, P =0.2). After multivariable logistic regression, TZP+VAN therapy was associated with an adjust odds ratio (aOR) of AKI of 1.54 (95% confidence interval [CI] 1.25–1.89) compared with FEP+VAN. Other variables associated with increased odds of AKI included: age >= 65, duration of antibiotic therapy, higher baseline renal function, sepsis, endocarditis, hepatorenal syndrome, thiazide diuretic exposure, and increased CCI. Conclusion Treatment with TZP+VAN is associated with significant increases in AKI incidence among critically ill patients, independent of other risks for AKI. Disclosures All authors: No reported disclosures.

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A multi-centre evaluation of the RIFLE criteria for early acute kidney injury in critically ill patients

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfn390 ◽

2008 ◽

Vol 23 (12) ◽

pp. 4072-4073 ◽

Cited By ~ 2

Author(s):

D. Morgan

Keyword(s):

Acute Kidney Injury ◽

Critically Ill ◽

Critically Ill Patients ◽

Kidney Injury ◽

Rifle Criteria

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A multi-centre evaluation of the RIFLE criteria for early acute kidney injury in critically ill patients

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfm744 ◽

2007 ◽

Vol 23 (4) ◽

pp. 1203-1210 ◽

Cited By ~ 307

Author(s):

S. M. Bagshaw ◽

C. George ◽

I. Dinu ◽

R. Bellomo

Keyword(s):

Acute Kidney Injury ◽

Critically Ill ◽

Critically Ill Patients ◽

Kidney Injury ◽

Rifle Criteria

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Evaluating Neutrophil Gelatinase-Associated Lipocalin as an Early Marker of Acute Kidney Injury in Critically Ill Patients

Nephro-Urology Monthly ◽

10.5812/numonthly.96351 ◽

2021 ◽

Vol In Press (In Press) ◽

Author(s):

Chettipunyam S Chetan ◽

Suhas Challa ◽

Manjunath S Shetty ◽

Sudarshana Murthy K A ◽

Kiran K Kelur ◽

...

Keyword(s):

Acute Kidney Injury ◽

Critically Ill ◽

Critically Ill Patients ◽

Kidney Injury ◽

Timely Manner ◽

Neutrophil Gelatinase Associated Lipocalin ◽

Rifle Criteria ◽

The Mean ◽

Neutrophil Gelatinase ◽

Important Marker

Background: Detecting significant renal injury in an accurate and timely manner in acute kidney injury (AKI) patients who are critically ill remains controversial. Serum creatinine (Cr) is an important marker of kidney function in clinical practice, and its limitations are well known. Objectives: This study aimed to evaluate neutrophil gelatinase-associated lipocalin (NGAL) as a marker of the early development of AKI in critically ill AKI patients. Methods: This prospective study was carried out at JSS Hospital, Mysuru, India. The diagnosis and staging of AKI was done according to the RIFLE criteria. Results: A total of 53 critically ill patients were enrolled in this study. During Intensive Care Unit (ICU) stay, 34 (64.2%) patients developed AKI according to RIFLE criteria. Serum NGAL levels assessed on admission were an appropriate predictor of AKI com-pared to serum Cr. Serum NGAL levels also showed a significant elevation among AKI patients than non-AKI cases. The mean levels for AKI patients at 0, 4, and 8 hours were 870.53, 1074.9, and 1090, respectively. Meanwhile, the mean levels for non-AKI patients at 0, 4, and 8 hours were 337, 307, and 292. Conclusions: Measuring serum NGAL on admission is useful in the early diagnosis of AKI com-pared to serum Cr.

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