RIFLE classification can predict short-term prognosis in critically ill cirrhotic patients.
OBJECTIVE
End-stage liver disease is frequently complicated by renal function disturbances. Cirrhotic patients with renal failure admitted to intensive care units (ICUs) have high mortality rates. This study analyzed the outcomes of critically ill cirrhotic patients and identified the association between prognosis and RIFLE (risk of renal failure, injury to kidney, failure of kidney function, loss of kidney function, and end-stage renal failure) classification, in comparison with other five scoring systems.


METHODS
Prospective, clinical study.


METHODS
Ten-bed specialized hepatogastroenterology ICU in a university hospital in Taiwan.


METHODS
One hundred and thirty-four cirrhotic patients consecutively admitted to ICU during a 1.5-year period.


METHODS
Thirty-two demographic, clinical and laboratory variables were analyzed as predictors of survival.


RESULTS
Overall hospital mortality was 65.7%. There was a progressive and significant increase (chi2 for trend: p<0.001) in mortality based on RIFLE classification severity. Multiple logistic regression analysis indicated that RIFLE classification and Sequential Organ Failure Assessment (SOFA) score on the first day of ICU admission were independent risk factors for hospital mortality. By using the areas under the receiver operating characteristic curve (AUROC), the RIFLE category and SOFA both indicated a good discriminative power (AUROC 0.837+/-0.036 and 0.917+/-0.025; p<0.001). Cumulative survival rates at 6-month follow-up differed significantly (p<0.05) for non-ARF vs. RIFLE-R, RIFLE-I, and RIFLE-F.


CONCLUSIONS
Both SOFA and RIFLE category showed high discriminative power in predicting hospital mortality in critically ill patients with cirrhosis. The RIFLE classification is a simple and easily applied evaluative tool with good prognostic abilities.
Jenq
Chang-Chyi
CC
Chang Gung University College of Medicine, Department of Nephrology, Chang Gung Memorial Hospital, 199 Tung Hwa North Road, 105 Taipei, Taiwan.
Tsai
Ming-Hung
MH
Tian
Ya-Chung
YC
Lin
Chan-Yu
CY
Yang
Chun
C
Liu
Nai-Jen
NJ
Lien
Jau-Min
JM
Chen
Yung-Chang
YC
Fang
Ji-Tseng
JT
Chen
Pan-Chi
PC
Yang
Chih-Wei
CW
D016638:Critical Illness; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D007676:Kidney Failure, Chronic / Q000145:classification* / Q000401:mortality; D008103:Liver Cirrhosis / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D011379:Prognosis; D011446:Prospective Studies; D016019:Survival Analysis; D013624:Taiwan / Q000453:epidemiology