The RIFLE score increases the accuracy of outcome prediction in patients with acute respiratory distress syndrome undergoing open lung biopsy.
BACKGROUND
Acute respiratory distress syndrome (ARDS) is a common diagnosis in intensive care units (ICUs) and is frequently correlated with acute kidney injury (AKI).


OBJECTIVE
To investigate the outcomes of critically ill patients with ARDS and to shed light on the association between prognosis and risk of renal failure, injury to kidney, failure of kidney function, loss of kidney function and end-stage renal failure (RIFLE) classification.


METHODS
This retrospective study investigated the medical records of 60 critically ill patients with ARDS who underwent open lung biopsy (OLB) in 2 medical intensive care units of a tertiary care hospital from December 1999 to May 2005.


RESULTS
The overall mortality rate was 55% (33/60). The increase in mortality was progressive and significant (chi(2) for trend, p < 0.001) with increasing severity of the RIFLE classification. The Glasgow coma scale, alveolar-arterial O(2) tension difference and maximum RIFLE (RIFLE(max)) score for days 1 and 3 in the ICU and on the day of OLB were independent predictors of hospital mortality by forward conditional logistic regression. Hosmer-Lemeshow goodness-of-fit test results demonstrate that RIFLE(max) has a good fit. The area under the receiver operating characteristic curve (AUROC) and RIFLE(max) score indicate good discriminative power (AUROC 0.750 +/- 0.063, p = 0.001). Cumulative survival rates at the 6-month follow-up following hospital discharge differed significantly (p < 0.05) for non-AKI versus RIFLE(max)-risk, RIFLE(max)-injury and RIFLE(max)-failure patients.


CONCLUSIONS
In patients with ARDS undergoing OLB, the use of the RIFLE score improves prediction of outcome.
Lin
Chan-Yu
CY
Department of Nephrology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taipei, Taiwan.
Kao
Kuo-Chin
KC
Tian
Ya-Chung
YC
Jenq
Chang-Chyi
CC
Chang
Ming-Yang
MY
Chen
Yung-Chang
YC
Fang
Ji-Tseng
JT
Huang
Chung-Chi
CC
Tsai
Ying-Huang
YH
Yang
Chih-Wei
CW
D058186:Acute Kidney Injury / Q000150:complications* / Q000175:diagnosis; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008168:Lung / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012128:Respiratory Distress Syndrome / Q000150:complications / Q000175:diagnosis / Q000401:mortality*; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013624:Taiwan / Q000453:epidemiology; D016896:Treatment Outcome