title: RIFLE classification can predict short-term prognosis in critically ill cirrhotic patients.
abstract: 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.
authors.affiliation: Chang Gung University College of Medicine, Department of Nephrology, Chang Gung Memorial Hospital, 199 Tung Hwa North Road, 105 Taipei, Taiwan.
authors.forename: Chang-Chyi
authors.initials: CC
authors.lastname: Jenq
authors.forename: Ming-Hung
authors.initials: MH
authors.lastname: Tsai
authors.forename: Ya-Chung
authors.initials: YC
authors.lastname: Tian
authors.forename: Chan-Yu
authors.initials: CY
authors.lastname: Lin
authors.forename: Chun
authors.initials: C
authors.lastname: Yang
authors.forename: Nai-Jen
authors.initials: NJ
authors.lastname: Liu
authors.forename: Jau-Min
authors.initials: JM
authors.lastname: Lien
authors.forename: Yung-Chang
authors.initials: YC
authors.lastname: Chen
authors.forename: Ji-Tseng
authors.initials: JT
authors.lastname: Fang
authors.forename: Pan-Chi
authors.initials: PC
authors.lastname: Chen
authors.forename: Chih-Wei
authors.initials: CW
authors.lastname: Yang
mesh_terms: 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