Prognostic Accuracy of the Kidney Disease: Improving Global Outcomes Criteria for In-Hospital Mortality Following...

The Risk, Injury, Failure, Loss of Kidney Function, and End-Stage Kidney Disease (RIFLE), Acute Kidney Injury Network (AKIN), and Kidney Disease: Improving Global Outcomes (KDIGO) criteria are widely used to define acute kidney injury (AKI). This study aimed to compare the impact of these criteria on the incidence of AKI and their prognostic accuracy for in-hospital mortality following cardiac surgery.

A retrospective cohort study.

An academic hospital in China.

A total of 2,396 adults (mean age, 60.3 ± 11.3 years; 58% male) undergoing cardiac surgery.

None.

AKI was defined separately using the RIFLE, AKIN, and KDIGO criteria. To evaluate the discriminatory performance of these definitions for in-hospital mortality, receiver operating characteristic (ROC) curves were constructed and the areas under the ROC curves (AUROCs) with 95% confidence intervals were calculated. The incidence of AKI as defined by the RIFLE, AKIN, and KDIGO criteria was 29.3%, 32.0%, and 36.5%, respectively. Eighty-four patients (3.7%) died during their hospital stay. Regardless of the definition used, crude in-hospital mortality was significantly higher in patients with AKI than in patients without AKI (RIFLE, 9.2% v 1.4%; AKIN, 9.7% v 0.8%; KDIGO, 8.8% v 0.7%; all p < 0.001). The KDIGO criteria demonstrated significantly greater prognostic accuracy for in-hospital mortality (AUROC, 0.90) compared with both the RIFLE and AKIN criteria (AUROC, 0.80 and 0.87, respectively; p < 0.05).

The KDIGO criteria demonstrated superior sensitivity for AKI diagnosis and were more strongly associated with in-hospital mortality compared with the RIFLE and AKIN criteria among patients undergoing cardiac surgery.