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Clinical evaluation of the new RIFLE criteria for acute renal failure
Critical Care volume 8, Article number: P162 (2004)
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.
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.
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Hoste, E., Clermont, G., Kersten, A. et al. Clinical evaluation of the new RIFLE criteria for acute renal failure. Crit Care 8, P162 (2004). https://doi.org/10.1186/cc2629
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Keywords
- Acute Renal Failure
- Hospital Mortality
- Urine Output
- Tertiary Hospital
- Anuria
