title: Predictive value of the RIFLE urine output criteria on contrast-induced nephropathy in critically ill patients.
abstract: BACKGROUND
  To investigate the predictive value of decreased urine output based on the Risk of renal dysfunction, Injury to the kidney, Failure of kidney function, Loss of kidney function and End-stage renal disease (RIFLE) classification on contrast- induced acute kidney injury (CA-AKI) in intensive care (ICU) patients.
  
  
  METHODS
  All patients who received contrast media (CM) injection for CT scan or coronary angiography during a 3-year period in a 24 bed medico-surgical ICU were reviewed.
  
  
  RESULTS
  Daily serum creatinine concentrations and diuresis were measured for 3 days after CM injection. We identified 23 cases of CA-AKI in the 149 patients included (15.4 %). Patients who developed CA-AKI were more likely to require renal replacement therapy and had higher ICU mortality rates. At least one RIFLE urine output criteria was observed in 45 patients (30.2 %) and 14 of these 45 patients (31.1 %) developed CA-AKI based on creatinine concentrations. In 30 % of these cases, urine output decreased or didn't change after the increase in creatinine concentrations. The RIFLE urine output criteria had low sensitivity (39.1 %) and specificity (67.9 %) for prediction of CA-AKI, a low positive predictive value of 50 % and a negative predictive value of 87.2 %. The maximal dose of vasopressors before CM was the only independent predictive factor for CA-AKI.
  
  
  CONCLUSIONS
  CA-AKI is a frequent pathology observed in ICU patients and is associated with increased need for renal replacement therapy and increased mortality. The predictive value of RIFLE urine output criteria for the development of CA-AKI based on creatinine concentrations was low, which limits its use for assessing the effects of therapeutic interventions on the development and progression of AKI.
authors.affiliation: Intensive Care, CHU-Charleroi, Université Libre de Bruxelles, 6042, Charleroi, Belgium.
authors.forename: Aldjia
authors.initials: A
authors.lastname: Hocine
authors.affiliation: Intensive Care, CHU-Charleroi, Université Libre de Bruxelles, 6042, Charleroi, Belgium.
authors.forename: Pierre
authors.initials: P
authors.lastname: Defrance
authors.affiliation: Cardiology, CHU-Charleroi, Université Libre de Bruxelles, 6042, Charleroi, Belgium.
authors.forename: Jacques
authors.initials: J
authors.lastname: Lalmand
authors.affiliation: Radiology, CHU-Charleroi, Université Libre de Bruxelles, 6042, Charleroi, Belgium.
authors.forename: Christian
authors.initials: C
authors.lastname: Delcour
authors.affiliation: Intensive Care, CHU-Charleroi, Université Libre de Bruxelles, 6042, Charleroi, Belgium.
authors.forename: Patrick
authors.initials: P
authors.lastname: Biston
authors.affiliation: Intensive Care, CHU-Charleroi, Université Libre de Bruxelles, 6042, Charleroi, Belgium. michael.piagnerelli@ulb.ac.be.|Experimental Medicine Laboratory, Université Libre de Bruxelles 222 Unit, CHU-Charleroi, 6111, Charleroi, Belgium. michael.piagnerelli@ulb.ac.be.
authors.forename: Michaël
authors.initials: M
authors.lastname: Piagnerelli
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced / Q000175:diagnosis* / Q000503:physiopathology; D000368:Aged; D001002:Anuria / Q000503:physiopathology*; D003287:Contrast Media / Q000009:adverse effects*; D017023:Coronary Angiography; D003404:Creatinine / Q000378:metabolism; D016638:Critical Illness; D018450:Disease Progression; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007676:Kidney Failure, Chronic / Q000139:chemically induced / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009026:Mortality; D009846:Oliguria / Q000503:physiopathology*; D011379:Prognosis; D051436:Renal Insufficiency, Chronic / Q000139:chemically induced / Q000175:diagnosis* / Q000503:physiopathology; D017582:Renal Replacement Therapy; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D014556:Urine
chemical_list: D003287:Contrast Media; D003404:Creatinine
keywords: Contrast-induced nephropathy; Critically ill; RIFLE; Renal failure