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  • Poster presentation
  • Open Access

Clinical evaluation of the new RIFLE criteria for acute renal failure

  • 1,
  • 1,
  • 1,
  • 1,
  • 1,
  • 1 and
  • 1
Critical Care20048 (Suppl 1) :P162

https://doi.org/10.1186/cc2629

  • Published:

Keywords

  • Acute Renal Failure
  • Hospital Mortality
  • Urine Output
  • Tertiary Hospital
  • Anuria

Background

The recently proposed RIFLE classification of acute renal failure (ARF) (Acute Dialysis Quality Initiative, http://www.ADQI.net) has yet to be evaluated in a general ICU population. RIFLE defines three grades of severity of ARF on the basis of either urine output (U) or an acute increase in serum creatinine (C): risk = C × 1.5 or U < 0.5 ml/kg/hour × 6 hours; injury = C × 2 or U < 0.5 ml/kg/hour × 12 hours; and failure = C × 3, C ≥ 4 mg/dl, U < 0.3 ml/kg/hour × 24 hours, or anuria × 12 hours.

Patients and methods

We prospectively collected data for all patients admitted to an ICU from 1 July 2000 to 30 June 2001 at the University of Pittsburgh Medical Center, a tertiary hospital with > 120 ICU beds serving medical, surgical, trauma, neurologic, and transplant patients. We tested two hypotheses: (1) increasing RIFLE class corresponds to decreasing ICU occurrence and increasing hospital mortality; and (2) patients classified by C or U criteria have similar occurrence and mortality. We classified patients according to their worst class on C or U criteria. For baseline C, we selected the lower of the admission C and the predicted C (based on age, sex, and race, using the Modification of Diet in Renal Disease formula).

Results

A total of 5754 admissions and 5313 patients were evaluated. Occurrence and mortality are presented in Table 1.
Table 1

:

 

RIFLE criteria

C criteria only

U criteria only

ICU occurrence (%)

   

   No ARF

32.0*

60.8*

29.3*

   Risk

12.1

13.1

11.1

   Injury

26.5

10.6

31.8

   Failure

29.4

15.6

27.8

Hospital mortality (%)

   

   No ARF

6.7**

6.7*

7.0**

   Risk

8.9

12.9

8.7

   Injury

11.1

23.8

10.9

   Failure

26.4

34.7

27.7

*P < 0.01, **P < 0.01, not for R vs I.

Conclusions

RIFLE criteria appear clinically sensible with increasing mortality. Unfortunately, C and U criteria alone yield different results, and occurrence decreases only when C criteria are used alone.

Authors’ Affiliations

(1)
CRISMA, University of Pittsburgh, Pennsylvania, USA

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