RIFLE classification in geriatric patients with acute kidney injury in the intensive care unit.
BACKGROUND
The RIFLE classification is widely used to assess the severity of acute kidney injury (AKI), but its application to geriatric AKI patients complicated by medical problems has not been reported.


METHODS
We investigated 256 geriatric patients (≥65 years old; mean age, 74.4 ± 6.3 years) who developed AKI in the intensive care unit (ICU) according to the RIFLE classification. Etiologic, clinical, and prognostic variables were analyzed.


RESULTS
They were categorized into RIFLE-R (n = 53), RIFLE-I (n = 102), and RIFLE-F (n = 101) groups. The overall in-hospital mortality was 39.8 %. There were no significant differences in RIFLE category between survivors and non-survivors. Survivors had significantly less needs for a ventilator and vasopressor, and lower number of failing organs. Survivors had higher systolic blood pressure, hemoglobin level, and serum albumin levels. We performed a logistic regression analysis to identify the independent predictors of in-hospital mortality. In a univariate analysis, hypertension, chronic kidney disease, RIFLE classification, number of failing organs, need for a ventilator and vasopressor, systolic blood pressure, hemoglobin level, and serum albumin levels were identified as prognostic factors of in-hospital mortality. However, in a multivariate analysis, hypertension, chronic kidney disease, number of failing organs, and serum albumin levels were independent risk factors, with no significant difference for in-hospital mortality with the RIFLE classification.


CONCLUSIONS
The RIFLE classification might not be associated with mortality in geriatric AKI patients in the ICU. In geriatric patients with AKI, various factors besides severity of AKI should be considered to predict mortality.
Department of Internal Medicine, Pusan National University School of Medicine, Busan, Republic of Korea.|Division of Nephrology, Biomedical Research Institute, Pusan National University Hospital, 179 Gudeok-ro, Seo-gu, Busan, 602-739, Republic of Korea.
Min Ji
MJ
Shin
Department of Internal Medicine, Pusan National University School of Medicine, Busan, Republic of Korea.|Division of Nephrology, Biomedical Research Institute, Pusan National University Hospital, 179 Gudeok-ro, Seo-gu, Busan, 602-739, Republic of Korea.
Harin
H
Rhee
Department of Internal Medicine, Pusan National University School of Medicine, Busan, Republic of Korea.
Il Young
IY
Kim
Department of Internal Medicine, Pusan National University School of Medicine, Busan, Republic of Korea.|Division of Nephrology, Biomedical Research Institute, Pusan National University Hospital, 179 Gudeok-ro, Seo-gu, Busan, 602-739, Republic of Korea.
Sang Heon
SH
Song
Department of Internal Medicine, Pusan National University School of Medicine, Busan, Republic of Korea.
Dong Won
DW
Lee
Department of Internal Medicine, Pusan National University School of Medicine, Busan, Republic of Korea.
Soo Bong
SB
Lee
Department of Internal Medicine, Pusan National University School of Medicine, Busan, Republic of Korea.|Division of Nephrology, Biomedical Research Institute, Pusan National University Hospital, 179 Gudeok-ro, Seo-gu, Busan, 602-739, Republic of Korea.
Ihm Soo
IS
Kwak
Department of Internal Medicine, Pusan National University School of Medicine, Busan, Republic of Korea. sey-0220@hanmail.net.|Division of Nephrology, Biomedical Research Institute, Pusan National University Hospital, 179 Gudeok-ro, Seo-gu, Busan, 602-739, Republic of Korea. sey-0220@hanmail.net.
Eun Young
EY
Seong
D058186:Acute Kidney Injury / Q000145:classification / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D016009:Chi-Square Distribution; D015897:Comorbidity; D005260:Female; D015577:Geriatric Assessment / Q000379:methods*; D006305:Health Status Indicators; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011379:Prognosis; D056910:Republic of Korea; D012189:Retrospective Studies; D012307:Risk Factors; D012709:Serum Albumin / Q000032:analysis; D000075462:Serum Albumin, Human; D012720:Severity of Illness Index
C422455:ALB protein, human; D015415:Biomarkers; D012709:Serum Albumin; D000075462:Serum Albumin, Human
Acute kidney injury; Geriatrics; Intensive care unit; Mortality