PURPOSE: This study is to evaluate if RIFLE criteria in acute kidney injury(AKI) could be used as a Prognostic indicator in critically ill septic-patients.
METHODS: Retrospective chart review of 75 ICU patients with the diagnosis of sepsis over a period of one year,who were divided into two groups:AKI-group and Control-group(no-AKI).AKI-group was further classified into RISK,INJURY and Failure groups based on maximum RIFLE class using creatinine and urine output criteria.They were compared for mortality,length of stay(LOS),ventilator-days,APACHE-score,need for renal-replacement,and the need for pressor-support.
RESULTS: 75-patients included in the study with mean age-69 and 62%females.The overall mortality was 36%.81% had AKI.AKI group had higher mortality compared to control group with no-AKI(42%vs7%,p=0.0013),higher-APACHE-score(24.4vs16.5,p-0.0003)and higher-vasopressor-use(52%vs14%,p=0.009).Higher RIFLE-class was associated with higher-mortality(Risk:0% vs Injury:27% vs Failure:56%,p=0.002),higher APACHE-score(mean: Risk:18.4 vs Injury:24.8 vs Failure:25.6,p=0.04)and higher vasopressor-use(Risk:11% vs Injury:45% vs Failure:63%,p=0.01).
CONCLUSION: AKI is common in ICU patients with sepsis and is associated with higher mortality,APACHE and vasopressor use. Higher RIFLE class is associated with higher mortality,APACHE and vasopressor use. The difference in ICU length of stay and ventilator days were not statistically significant between the different AKI subgroups.
CLINICAL IMPLICATIONS: RIFLE criteria can be used as a prognostic indicator in critically ill septic patients. Early recognition of AKI with the help of RIFLE will enable us to be more aggressive in preventing further renal loss and probably may improve outcome.
DISCLOSURE: Srujana Polsani, No Financial Disclosure Information; No Product/Research Disclosure Information