A comparison of acute kidney injury classification systems in sepsis.
BACKGROUND
Since 2004, various criteria have been proposed to define and stage acute kidney injury (AKI). Nevertheless, fixed criteria for assessing severe sepsis-related AKI have not yet been established.


OBJECTIVE
To assess the ability of the different AKI classification methods to predict mortality in a cohort of patients with sepsis.


METHODS
A prospective study of patients>18 years with septic shock admitted to the intensive care unit (ICU) of our hospital from April 2008 to September 2010 was conducted. Plasma creatinine levels were measured daily in the ICU. Patients were classified retrospectively according to RIFLE, AKIN, KDIGO and creatinine kinetics (CK) criteria.


RESULTS
The AKI rate according to the different criteria was 74.3% for RIFLE, 81.7% for AKIN, 81.7% for KDIGO and 77.5% for CK. AKI staging by RIFLE (OR 1.452, P=.003), AKIN (OR 1.349, P=.028) and KDIGO criteria (OR 1.452, P=.006), but not CK criteria (OR 1.188, P=.148) were independently related to in-hospital mortality.


CONCLUSIONS
A high rate of patients with severe sepsis developed AKI, which can be classified according to different criteria. Each stage defined by RIFLE, AKIN and KDIGO related to a higher risk of in-hospital mortality. In contrast, the new CK criteria did not relate to higher mortality in patients with severe sepsis and this classification should not be used in these patients without further studies assessing its suitability.
Servicio de Nefrología, Hospital Universitario Marqués de Valdecilla, Santander (Cantabria), España. Electronic address: nefrce@humv.es.
Emilio
E
Rodrigo
Unidad de Cuidados Intensivos, Hospital Universitario Marqués de Valdecilla, Santander (Cantabria), España.
Borja
B
Suberviola
Servicio de Nefrología, Hospital Universitario Marqués de Valdecilla, Santander (Cantabria), España.
Zoila
Z
Albines
Unidad de Cuidados Intensivos, Hospital Universitario Marqués de Valdecilla, Santander (Cantabria), España.
Álvaro
Á
Castellanos
Servicio de Nefrología, Hospital Universitario Marqués de Valdecilla, Santander (Cantabria), España.
Milagros
M
Heras
Unidad de Cuidados Intensivos, Hospital Universitario Marqués de Valdecilla, Santander (Cantabria), España.
Juan Carlos
JC
Rodriguez-Borregán
Servicio de Nefrología, Hospital Universitario Marqués de Valdecilla, Santander (Cantabria), España.
Celestino
C
Piñera
Servicio de Nefrología, Hospital Universitario Marqués de Valdecilla, Santander (Cantabria), España.
Mara
M
Serrano
Servicio de Nefrología, Hospital Universitario Marqués de Valdecilla, Santander (Cantabria), España.
Manuel
M
Arias
D058186:Acute Kidney Injury / Q000145:classification* / Q000401:mortality; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D018805:Sepsis / Q000150:complications*; D012772:Shock, Septic / Q000150:complications*
Acute kidney injury; Fracaso renal agudo; Mortalidad; Mortality; Sepsis