title: Risk factors of acute kidney injury according to RIFLE criteria after lung cancer surgery.
abstract: BACKGROUND
  Perioperative acute kidney injury (AKI) is associated with increased mortality and morbidity. Our aim was to evaluate the incidence and determinants of AKI using the risk, injury, failure, loss of function, and end-stage kidney disease (RIFLE) criteria in thoracic surgical patients.
  
  
  METHODS
  We retrospectively analyzed a cohort of patients undergoing lung cancer surgery from 1996 to 2009. Patient management was protocol-driven, and postoperative complications were prospectively collected. The primary outcome was AKI within 3 days after surgery. A variety of patient comorbidities and operative characteristics were evaluated as potential predictors of AKI using a multiple logistic regression model.
  
  
  RESULTS
  Complete data were obtained from 1,345 patients, and the incidence of AKI was 6.8%. Four independent risk factors for AKI were identified: American Society of Anesthesiologists classes 3 and 4 (odds ratio [OR] 2.60, 95% confidence interval [CI]: 1.03 to 6.55), forced expiratory volume in 1 second (OR 0.55, 95% CI: 0.32 to 0.96), the use of vasopressors (OR 1.015, 95% CI: 0.998 to 1.035), and the duration of anesthesia (OR 1.044, 95% CI: 1.001 to 1.008). Patients who experienced AKI were more frequently admitted to the intensive care unit (24.2% versus 3.5% for patients without AKI, p < 0.05); they had increased mortality (19.8% versus 1.1%, p < 0.05) and a threefold to fourfold higher incidence of cardiopulmonary complications.
  
  
  CONCLUSIONS
  The RIFLE classification is a valuable tool to assess AKI after lung cancer surgery. The severity of perioperative renal impairment is associated with increased mortality and morbidity.
authors.affiliation: Department of Anesthesiology, Pharmacology and Intensive Care, Faculty of Medicine, University Hospital, University of Geneva, Geneva, Switzerland. licker-marc-joseph@diogenes.hcuge.ch
authors.forename: Marc
authors.initials: M
authors.lastname: Licker
authors.forename: Vanessa
authors.initials: V
authors.lastname: Cartier
authors.forename: John
authors.initials: J
authors.lastname: Robert
authors.forename: John
authors.initials: J
authors.lastname: Diaper
authors.forename: Yann
authors.initials: Y
authors.lastname: Villiger
authors.forename: Jean-Marie
authors.initials: JM
authors.lastname: Tschopp
authors.forename: Cigdem
authors.initials: C
authors.lastname: Inan
mesh_terms: D058186:Acute Kidney Injury / Q000145:classification / Q000453:epidemiology / Q000209:etiology*; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008175:Lung Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy / Q000009:adverse effects*; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D015996:Survival Rate / Q000639:trends; D013557:Switzerland / Q000453:epidemiology