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제목	RIFLE Classification in Geriatric Patients with Acute Kidney Injury in the Intensive Care Unit
저자	Min Ji Shin1, Harin Rhee1, Byeong Yun Yang1, Jang Won Lee1, Sang Heon Song1,Eun Young Seong1, Ihm Soo Kwak1, Kyung Joo Park2
출판정보	2014; 2014(1):
키워드	급성신손상, 노인, 사망률
초록	Background: The RIFLE classification is widely used to gauge the severity of acute kidney injury (AKI), but its efficacy has not been formally tested in geriatric patients. In this study, we studied 256 elderly patients(65 years of age or older) who developed AKI in intensive care unit (ICU) in accordance with the RIFLE creatinine criteria. Methods: Patients were eligible for enrollment if they were developed AKI in ICU between January 2009 and April 2013. Exclusion criteria included patients on maintenance dialysis (defined as >3 months of renal replacement therapy) and stayed in the ICU for <48 h. We used the sRIFLE classification system in which only creatinine levels are used to classify patients. Etiology, clinical, and prognostic variables were analyzed. Results: The mean age was 74.4±6.3 years. The cause of AKI was dehydration (11.7%), infection (47.3%), bleeding (4.3%), contrast material (3.1%), drugs (5.1%), obstruction (2.3%), cardiogenic shock (17.2%), renal infarction (1.2 %), rhabdomyolysis (3.9%), and hepatorenal syndrome (0.4%). They were categorized into RIFLE-R (n=53, 20.7%), RIFLE-I (n=102, 39.8%), and RIFLE-F (n=101, 39.5%) groups. Among the 256 patients, 97 (37.9%) died during index hospitalization (19 days, interquartile range 10-34). Age was not significant factor discriminating between survivors and non-survivors. The in-hospital mortality rates for the RIFLE-R, RIFLE-I, and RIFLE-F groups were 14.4%, 44.3 %, and 41.2%, respectively. In comparison of the clinical and biochemical variables according to mortalities, SBP, Hb, albumin were significantly higher, and number of failing organs and peak BUN were significantly lower in survivors. Non-survivors needed more ventilator care and vasopressor treatment. A logistic regression analysis was performed to identify the independent predictors for in-hospital mortality. There was no significant associations between RIFLE groups (for RIFLE-I vs.-R: odds ratio (OR),2.03; 95% confidence interval (CI), 0.98-4.19; p=0.56; for RIFLE-F vs. -R: OR, 1.82; 95% CI, 0.88-3.78; p=0.11). After adjustment, Hb and number of failing organs were significantly associated with higher in-hospital mortality rates, however, RIFLE-R,-I, or -F classifications were not significantly associated with increased hospital mortality. Conclusions: RILFE classification might not be associated with mortality rate in geriatric patients in ICU. In geriatric patients with acute kidney injury inICU, various factors should be considered other than serum creatinine.
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