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RIFLE classification is predictive of short-term prognosis in critically ill patients with acute renal failure supported by extracorporeal membrane oxygenation.
Nephrol Dial Transplant. 2006 Oct; 21(10):2867-73.ND

Abstract

BACKGROUND

Extracorporeal membrane oxygenation (ECMO) has been utilized for critically ill patients, such as those with post-cardiotomy cardiogenic shock or life-threatening respiratory failure. Acute renal failure following ECMO support has an extremely elevated mortality rate. This study examined the outcomes of patients treated with ECMO and characterized the association between mortality and RIFLE (risk of renal failure, injury to the kidney, failure of kidney function, loss of kidney function and end-stage renal failure) classification.

METHODS

This retrospective study analysed the medical records of 46 critically ill patients-most had post-cardiotomy cardiogenic shock-treated by ECMO. Sixteen patients (34.8%) were treated with both ECMO and continuous renal replacement therapies.

RESULTS

The overall mortality rate was 65.2% (30/46). A progressive and significant increase (chi(2) for trend, P < 0.001) was observed for mortality based on RIFLE classification severity. The Hosmer and Lemeshow goodness-of-fit test demonstrated that the RIFLE category has a good fit. By applying the area under the receiver operating characteristic curve (AUROC), the RIFLE classification tool had good discriminative power (AUROC 0.868 +/- 0.068, P < 0.001). Cumulative survival rates at 6 months follow-up following hospital discharge differed significantly (P < 0.05) for non-ARF vs RIFLE-I and RIFLE-F, and RIFLE-R vs RIFLE-F.

CONCLUSION

This investigation confirms that the prognosis for critically ill patients supported by ECMO is grave. The RIFLE category is a simple, reproducible and easily applied evaluation tool with good prognostic capability that might generate objective information for patient families and physicians and supplements the clinical judgment of prognosis.

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Authors+Show Affiliations

Lin CY
Department of Nephrology, Chang Gung Memorial Hospital, 199 Tung Hwa North Road, 105 Taipei, Taiwan.
Chen YC
No affiliation info available
Tsai FC
No affiliation info available
Tian YC
No affiliation info available
Jenq CC
No affiliation info available
Fang JT
No affiliation info available
Yang CW
No affiliation info available

MeSH

Acute Kidney InjuryAdultAgedAnalysis of VarianceCritical IllnessExtracorporeal Membrane OxygenationFemaleHospital MortalityHumansMaleMiddle AgedMultiple Organ FailurePrognosisROC CurveRetrospective StudiesSeverity of Illness IndexSurvival AnalysisTreatment Outcome

Pub Type(s)

Journal Article

Language

eng

PubMed ID

16799171

Citation

Lin, Chan-Yu, et al. "RIFLE Classification Is Predictive of Short-term Prognosis in Critically Ill Patients With Acute Renal Failure Supported By Extracorporeal Membrane Oxygenation." Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association, vol. 21, no. 10, 2006, pp. 2867-73.
Lin CY, Chen YC, Tsai FC, et al. RIFLE classification is predictive of short-term prognosis in critically ill patients with acute renal failure supported by extracorporeal membrane oxygenation. Nephrol Dial Transplant. 2006;21(10):2867-73.
Lin, C. Y., Chen, Y. C., Tsai, F. C., Tian, Y. C., Jenq, C. C., Fang, J. T., & Yang, C. W. (2006). RIFLE classification is predictive of short-term prognosis in critically ill patients with acute renal failure supported by extracorporeal membrane oxygenation. Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association, 21(10), 2867-73.
Lin CY, et al. RIFLE Classification Is Predictive of Short-term Prognosis in Critically Ill Patients With Acute Renal Failure Supported By Extracorporeal Membrane Oxygenation. Nephrol Dial Transplant. 2006;21(10):2867-73. PubMed PMID: 16799171.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - RIFLE classification is predictive of short-term prognosis in critically ill patients with acute renal failure supported by extracorporeal membrane oxygenation. AU - Lin,Chan-Yu, AU - Chen,Yung-Chang, AU - Tsai,Feng-Chun, AU - Tian,Ya-Chung, AU - Jenq,Chang-Chyi, AU - Fang,Ji-Tseng, AU - Yang,Chin-Wei, Y1 - 2006/06/24/ PY - 2006/6/27/pubmed PY - 2007/4/3/medline PY - 2006/6/27/entrez SP - 2867 EP - 73 JF - Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association JO - Nephrol Dial Transplant VL - 21 IS - 10 N2 - BACKGROUND: Extracorporeal membrane oxygenation (ECMO) has been utilized for critically ill patients, such as those with post-cardiotomy cardiogenic shock or life-threatening respiratory failure. Acute renal failure following ECMO support has an extremely elevated mortality rate. This study examined the outcomes of patients treated with ECMO and characterized the association between mortality and RIFLE (risk of renal failure, injury to the kidney, failure of kidney function, loss of kidney function and end-stage renal failure) classification. METHODS: This retrospective study analysed the medical records of 46 critically ill patients-most had post-cardiotomy cardiogenic shock-treated by ECMO. Sixteen patients (34.8%) were treated with both ECMO and continuous renal replacement therapies. RESULTS: The overall mortality rate was 65.2% (30/46). A progressive and significant increase (chi(2) for trend, P < 0.001) was observed for mortality based on RIFLE classification severity. The Hosmer and Lemeshow goodness-of-fit test demonstrated that the RIFLE category has a good fit. By applying the area under the receiver operating characteristic curve (AUROC), the RIFLE classification tool had good discriminative power (AUROC 0.868 +/- 0.068, P < 0.001). Cumulative survival rates at 6 months follow-up following hospital discharge differed significantly (P < 0.05) for non-ARF vs RIFLE-I and RIFLE-F, and RIFLE-R vs RIFLE-F. CONCLUSION: This investigation confirms that the prognosis for critically ill patients supported by ECMO is grave. The RIFLE category is a simple, reproducible and easily applied evaluation tool with good prognostic capability that might generate objective information for patient families and physicians and supplements the clinical judgment of prognosis. SN - 0931-0509 UR - https://www.unboundmedicine.com/medline/citation/16799171/RIFLE_classification_is_predictive_of_short_term_prognosis_in_critically_ill_patients_with_acute_renal_failure_supported_by_extracorporeal_membrane_oxygenation_ L2 - https://academic.oup.com/ndt/article-lookup/doi/10.1093/ndt/gfl326 DB - PRIME DP - Unbound Medicine ER -