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      Incidence and outcomes of acute kidney injury after cardiac surgery using either criteria of the RIFLE classification.

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          Abstract

          Adult cardiac surgery is significantly associated with the development of acute kidney injury (AKI). Still, the incidence and outcomes of AKI vary according to its definition. Our retrospective monocentric study comparatively investigates the yield of RIFLE definition, which is based on the elevation of serum creatinine levels (SCr) or the reduction of urine output (UO), taking into account only one or both criteria. Pre- and per-operative risk factors for post-operative AKI were evaluated.

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          A simple risk score for prediction of contrast-induced nephropathy after percutaneous coronary intervention: development and initial validation.

          Roxana Mehran, Eve Aymong, Eugenia Nikolsky … (2004)
          We sought to develop a simple risk score of contrast-induced nephropathy (CIN) after percutaneous coronary intervention (PCI). Although several risk factors for CIN have been identified, the cumulative risk rendered by their combination is unknown. A total of 8,357 patients were randomly assigned to a development and a validation dataset. The baseline clinical and procedural characteristics of the 5,571 patients in the development dataset were considered as candidate univariate predictors of CIN (increase >or=25% and/or >or=0.5 mg/dl in serum creatinine at 48 h after PCI vs. baseline). Multivariate logistic regression was then used to identify independent predictors of CIN with a p value 75 years, anemia, and volume of contrast) were assigned a weighted integer; the sum of the integers was a total risk score for each patient. The overall occurrence of CIN in the development set was 13.1% (range 7.5% to 57.3% for a low [ or=16] risk score, respectively); the rate of CIN increased exponentially with increasing risk score (Cochran Armitage chi-square, p < 0.0001). In the 2,786 patients of the validation dataset, the model demonstrated good discriminative power (c statistic = 0.67); the increasing risk score was again strongly associated with CIN (range 8.4% to 55.9% for a low and high risk score, respectively). The risk of CIN after PCI can be simply assessed using readily available information. This risk score can be used for both clinical and investigational purposes.
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            European system for cardiac operative risk evaluation (EuroSCORE).

            S Nashef, F. Roques, P. Michel … (1999)
            To construct a scoring system for the prediction of early mortality in cardiac surgical patients in Europe on the basis of objective risk factors. The EuroSCORE database was divided into developmental and validation subsets. In the former, risk factors deemed to be objective, credible, obtainable and difficult to falsify were weighted on the basis of regression analysis. An additive score of predicted mortality was constructed. Its calibration and discrimination characteristics were assessed in the validation dataset. Thresholds were defined to distinguish low, moderate and high risk groups. The developmental dataset had 13,302 patients, calibration by Hosmer Lemeshow Chi square was (8) = 8.26 (P 200 micromol/l (2), active endocarditis (3) and critical preoperative state (3). Cardiac factors were unstable angina on intravenous nitrates (2), reduced left ventricular ejection fraction (30-50%: 1, 60 mmHg (2). Operation-related factors were emergency (2), other than isolated coronary surgery (2), thoracic aorta surgery (3) and surgery for postinfarct septal rupture (4). The scoring system was then applied to three risk groups. The low risk group (EuroSCORE 1-2) had 4529 patients with 36 deaths (0.8%), 95% confidence limits for observed mortality (0.56-1.10) and for expected mortality (1.27-1.29). The medium risk group (EuroSCORE 3-5) had 5977 patients with 182 deaths (3%), observed mortality (2.62-3.51), predicted (2.90-2.94). The high risk group (EuroSCORE 6 plus) had 4293 patients with 480 deaths (11.2%) observed mortality (10.25-12.16), predicted (10.93-11.54). Overall, there were 698 deaths in 14,799 patients (4.7%), observed mortality (4.37-5.06), predicted (4.72-4.95). EuroSCORE is a simple, objective and up-to-date system for assessing heart surgery, soundly based on one of the largest, most complete and accurate databases in European cardiac surgical history. We recommend its widespread use.
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              The RIFLE criteria and mortality in acute kidney injury: A systematic review.

              Z Ricci, D. Cruz, C. Ronco (2008)
              In 2004, the Acute Dialysis Quality Initiative workgroup proposed a multilevel classification system for acute kidney injury (AKI) identified by the acronym RIFLE (Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease). Several studies have been published aiming to validate and apply it in clinical practice, verifying whether outcome progressively worsened with the severity of AKI. A literature search from August 2004 to June 2007 was conducted: 24 studies in which the RIFLE classification was used to define AKI were identified. In 13 studies, patient-level data on mortality were available for Risk, Injury, and Failure patients, as well as those without AKI (non-AKI). Death was reported at ICU discharge, hospital discharge, 28, 30, 60, and 90 days. The pooled estimate of relative risk (RR) for mortality for patients with R, I, or F levels compared with non-AKI patients were analyzed. Over 71 000 patients were included in the analysis of published reports. With respect to non-AKI, there appeared to be a stepwise increase in RR for death going from Risk (RR=2.40) to Injury (RR=4.15) to Failure (6.37, P<0.0001 for all). There was significant intertrial heterogeneity as expected with the varying patient populations studied. The RIFLE classification is a simple, readily available clinical tool to classify AKI in different populations. It seems to be a good outcome predictor, with a progressive increase in mortality with worsening RIFLE class. It also suggests that even mild degrees of kidney dysfunction may have a negative impact on outcome. Further refinement of RIFLE nomenclature and classification is ongoing.
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                Author and article information

                Journal
                Journal ID (iso-abbrev): BMC Nephrol
                Title: BMC nephrology
                Publisher: Springer Nature
                ISSN (Electronic): 1471-2369
                ISSN (Print): 1471-2369
                Publication date (Electronic): May 30 2015
                Volume: 16
                Affiliations
                [1 ] Division of Cardio-vascular and Thoracic Surgery, ULg CHU, Liège, Belgium. mglagny@chu.ulg.ac.be.
                [2 ] Division of Nephrology, University of Liège Hospital (ULg CHU), Avenue de l'Hôpital, 1, B-4000, Liège, Belgium. francois.jouret@chu.ulg.ac.be.
                [3 ] Department of Medical Informatics and Biostatistics, Public Health, ULg, Liège, Belgium. jnkoch@alumni.ulg.ac.be.
                [4 ] Division of Cardio-vascular and Thoracic Surgery, ULg CHU, Liège, Belgium. francine.blaffart@chu.ulg.ac.be.
                [5 ] Department of Medical Informatics and Biostatistics, Public Health, ULg, Liège, Belgium. afdonneau@ulg.ac.be.
                [6 ] Department of Medical Informatics and Biostatistics, Public Health, ULg, Liège, Belgium. aalbert@ulg.ac.be.
                [7 ] Division of Anaesthesiology, ULg CHU, Liège, Belgium. loroediger@yahoo.fr.
                [8 ] Division of Nephrology, University of Liège Hospital (ULg CHU), Avenue de l'Hôpital, 1, B-4000, Liège, Belgium. jm.krzesinski@chu.ulg.ac.be.
                [9 ] Division of Cardio-vascular and Thoracic Surgery, ULg CHU, Liège, Belgium. jo.Defraigne@chu.ulg.ac.be.
                Article
                Publisher Item ID: 10.1186/s12882-015-0066-9
                DOI: 10.1186/s12882-015-0066-9
                PMC ID: 4448315
                PubMed ID: 26025079
                SO-VID: ad943530-7222-4c04-a475-936906798159
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