The Acute Kidney Injury Network (AKIN) criteria applied in burns.
ABSTRACT In 2007, the Acute Kidney Injury Network (AKIN) developed a modified standard for diagnosing and classifying acute kidney injury (AKI). This classification system is a modification of the previously described risk, injury, failure, loss, and end-stage (RIFLE) criteria. Among other modifications, the AKIN staging requires an absolute serum creatinine change of 0.3 mg/dl in a 48-hour period to establish the diagnosis of AKI. The purpose of this study was to apply these new criteria in the severely burned population and to compare the prevalence, stage, and mortality impact of these criteria to the RIFLE criteria. The authors performed a retrospective analysis of consecutive patients with burns admitted to their burn center for at least 24 hours from June 2003 through December 2008. Each patient was classified by both the AKIN and RIFLE criteria by three referees. Both univariate and multivariate analyses were performed to determine the impact of the various AKI stages on mortality. A total of 1973 patients met inclusion and exclusion criteria and were included in the analysis. The average age, %TBSA, injury severity score, and percent with smoke inhalation injury were 36 ± 16, 16 ± 18, 10 ± 12, and 13%, respectively. Overall, the prevalence of AKI was 33% using the AKIN criteria and 24% using the RIFLE criteria with an associated mortality of 21 and 25%, respectively. Of those meeting criteria for AKIN stage 1 (N = 434), 41% (N = 180) would have been categorized as not having AKI on the basis of the RIFLE criteria. In this cohort of patients, mortality increased by almost 8-fold when compared with those without AKI (odds ratio 7.8 [95% confidence interval (CI) 3.7-16.2], P < .0001). The area under the receiver operator characteristic curve for in-hospital mortality was significantly higher for the AKIN criteria at 0.877 (95% CI 0.848-0.906) when compared to the RIFLE criteria at 0.838 (95% CI 0.801-0.874; P = .0007). Burn patients identified as having AKI by the AKIN criteria missed by RIFLE appear to be an important cohort. On the basis of our study, AKIN criteria may be more precise and are more predictive of death than the RIFLE criteria in this population. Prospective validation is needed.
SourceAvailable from: Rajeev Annigeri[Show abstract] [Hide abstract]
ABSTRACT: Abstract Although the epidemiology and the impact of Acute Kidney Injury on outcomes are well-known in the Western literature, good data is lacking from India. Most studies published from India have not evaluated epidemiology of Acute Kidney Injury in the Intensive Care Unit setting and/or have not used validated criteria. In our observational study of 250 patients, admitted to a tertiary level ICU, we have explored the epidemiology of Acute Kidney Injury using both RIFLE and AKIN criteria and have validated them. We have also demonstrated that the severity of AKI is an independent predictor of mortality in critically ill patients. Our results are very much comparable to other studies and we feel that this study will remain as an epidemiological reference point for Indian clinicians dealing with AKI.Renal Failure 04/2014; 36(6). DOI:10.3109/0886022X.2014.899432 · 0.78 Impact Factor
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ABSTRACT: Acute kidney injury (AKI) is a serious complication after repair of a ruptured abdominal aortic aneurysm (RAAA). In the present Society for Vascular Surgery (SVS)/International Society for CardioVascular Surgery (ISCVS) reporting standards patients are classified as no dialysis (grade I), as temporary dialysis (grade II), and as permanent dialysis or fatal outcome (grade III). However, AKI is a broad clinical syndrome including more than the requirement for renal replacement therapy. The recently introduced 'Risk,' 'Injury,' 'Failure,' 'Loss,' and 'End-stage' (RIFLE) classification for AKI comprises three severity categories based on serum creatinine and urine output ('Risk,' 'Injury,' and 'Failure'). The objective of the present study was to assess the incidence of AKI using the RIFLE criteria (AKIRIFLE). Secondary objectives were to assess the incidence of AKI as defined using the SVS/ISCVS reporting standards (AKISVS/ISCVS) and the association between AKIRIFLE and death.Journal of Vascular Surgery 07/2014; 60(5). DOI:10.1016/j.jvs.2014.04.072 · 2.98 Impact Factor
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ABSTRACT: Survival rates of burn patients have increased greatly over the past several decades. There are, however, still patients with relatively small burns who do not survive their hospitalizations. This work aimed to elucidate factors common to this select subset of patients. The NBR Main dataset was queried for record numbers associated with TBSA between 0.1 and 10 and a discharge status indicating death. Using SAS statistical software, the patients were matched for age, sex, and TBSA. Chi-square analyses of independence on categorical variables and unpaired, two-tailed Students' t-tests with unequal variance on continuous variables were used to identify fields of further interest. SAS was then used to build multivariate logistic regression models examining variables affecting discharge status. The NBR complications child dataset was queried and categorized for the types of complications for analysis. Multivariate logistic regression for discharge status, comorbidities, and complications showed that the presence of a complication significantly impacted discharge status. The presence of an identified complication (other than death) increased the odds ratio of a discharge status of death by a factor of 3.023 (95% confidence interval [2.306, 3.964], P < .0001). Pulmonary and infection-related complications were the most frequently seen across all the records analyzed, but infection-related complications did not reach statistical significance in relation to discharge status. Multivariate logistic regression of complications in a model for discharge status identified four categories as statistically significant: neurologic, cardiovascular, pulmonary, and renal. In patients with small TBSA burns, the presence of complications significantly increases the odds ratio of death as judged by the NBR data. The complications which appear to be of particular interest are cardiovascular, neurologic, renal, and pulmonary, and those patients who are likely most susceptible to these complications are those with inhalation injury in addition to their cutaneous burns.Journal of burn care & research: official publication of the American Burn Association 08/2014; 36(1). DOI:10.1097/BCR.0000000000000113 · 1.55 Impact Factor