title: Analysis of progression in risk, injury, failure, loss, and end-stage renal disease classification on outcome in patients with severe sepsis and septic shock.
abstract: BACKGROUND
  A few studies have assessed risk, injury, failure, loss, and end-stage renal disease (RIFLE) criteria in patients with severe sepsis and septic shock, a setting in which acute kidney injury (AKI) is common and dramatically worsens outcome.
  
  
  METHODS
  Study subjects included all consecutive patients with severe sepsis and septic shock who had been admitted to the medical intensive care unit between January 2005 and December 2006.
  
  
  RESULTS
  Of 326 patients admitted during the study period, 291 were included. According to RIFLE criteria, 204 patients (70.1%) had AKI (risk, 26.1%; injury, 26.5%; failure, 17.5%) on admission. Overall, 28-day mortality rate was 48.5%. Mortality was not associated with admission RIFLE (risk, 44.7%; injury, 53.2%; failure, 51.0%; P = .58). However, maximum RIFLE was associated with increased 28-day mortality (P < .01). After adjustment for age, sex, Acute Physiology and Chronic Health Evaluation II score, and Sequential Organ Failure Assessment score, independent risk factors for 28-day mortality were newly developed AKI (odds ratio [OR], 11.4; P < .01), progression of RIFLE risk to higher RIFLE class (OR, 14.5; P < .01), maximum RIFLE injury (OR, 5.58; P < .01), and maximum RIFLE failure (OR, 7.64; P < .01).
  
  
  CONCLUSIONS
  Progression of RIFLE class and newly developed AKI after hospital admission were better able to predict 28-day mortality than RIFLE criteria on the first day of admission in patients with severe sepsis and septic shock.
authors.affiliation: Department of Emergency Medicine, Ulsan University College of Medicine, Asan Medical Center, Seoul, South Korea.
authors.forename: Won Young
authors.initials: WY
authors.lastname: Kim
authors.forename: Jin Won
authors.initials: JW
authors.lastname: Huh
authors.forename: Chae-Man
authors.initials: CM
authors.lastname: Lim
authors.forename: Younsuck
authors.initials: Y
authors.lastname: Koh
authors.forename: Sang-Bum
authors.initials: SB
authors.lastname: Hong
mesh_terms: D058186:Acute Kidney Injury / Q000145:classification* / Q000473:pathology; D000368:Aged; D018450:Disease Progression; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D007676:Kidney Failure, Chronic / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D018805:Sepsis / Q000401:mortality* / Q000628:therapy; D012772:Shock, Septic / Q000401:mortality / Q000628:therapy