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Correlation between the AKI classification and outcome.
Marlies Ostermann1, Rene Chang,
1Department of Critical Care, Guy's & St Thomas' Foundation Hospital, Westminster Bridge Road, London SE1 7EH, UK. marlies@ostermann.freeserve.co.uk
Critical Care (London, England)
|November 21, 2008
Summary
The Acute Kidney Injury Network classification shows that severe Acute Kidney Injury (AKI III) independently predicts intensive care unit mortality. However, using renal replacement therapy in the AKI III criteria may affect its predictive accuracy.
Area of Science:
- Nephrology
- Critical Care Medicine
- Epidemiology
Background:
- The Acute Kidney Injury Network (AKIN) proposed a three-stage classification for acute kidney injury (AKI).
- This study evaluated the AKIN criteria in a large intensive care unit (ICU) population.
- The impact of AKI on mortality was assessed alongside other risk factors.
Purpose of the Study:
- To apply the AKIN classification to a large ICU cohort.
- To determine the association between AKI stages and ICU mortality.
- To evaluate the influence of renal replacement therapy on AKI classification and outcome prediction.
Main Methods:
- Utilized the Riyadh Intensive Care Program database.
- Included 22,303 adult patients admitted to 22 ICUs in the UK and Germany (1989-1999).
- Applied AKIN criteria to patients with ICU stays >= 24 hours and no end-stage renal failure.
Main Results:
- 35.4% of patients developed AKI (19.1% AKI I, 3.8% AKI II, 12.5% AKI III).
- ICU mortality increased with AKI stage: 10.7% (no AKI) to 49.6% (AKI III).
- AKI III was independently associated with ICU mortality (OR=2.27); AKI I and II were not. Other factors included age, SOFA score, and organ failure.
Conclusions:
- The AKIN classification correlates with ICU outcomes.
- Only AKI III emerged as an independent predictor of ICU mortality.
- Including renal replacement therapy in AKI III criteria may confound predictive power.
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