Elsevier

The Annals of Thoracic Surgery

Volume 90, Issue 6, December 2010, Pages 1939-1943
The Annals of Thoracic Surgery

Original article
Adult cardiac
Cardiac Surgery-Associated Acute Kidney Injury: A Comparison of Two Consensus Criteria

https://doi.org/10.1016/j.athoracsur.2010.08.018Get rights and content

Background

Cardiac surgery-related acute kidney injury has short- and long-term impact on patients' risk for further morbidity and mortality. Consensus statements have yielded criteria—such as the risk, injury, failure, loss, and end-stage kidney disease (RIFLE) criteria, and the Acute Kidney Injury Network (AKIN) criteria—to define the type and consequence of acute kidney injury. We sought to estimate the ability of both the RIFLE and and AKIN criteria to predict the risk of in-hospital mortality in the setting of cardiac surgery.

Methods

Data were collected on 25,086 patients undergoing cardiac surgery in Northern New England from January 2001 to December 2007, excluding 339 patients on preoperative dialysis. The AKIN and RIFLE criteria were used to classify patients postoperatively, using the last preoperative and the highest postoperative serum creatinine. We compared the diagnostic properties of both criteria, and calculated the areas under the receiver operating characteristic curve.

Results

Acute kidney injury occurred in 30% of patients using the AKIN criteria and in 31% of patients using the RIFLE criteria. The areas under the receiver operating characteristic curve for in-hospital mortality estimated by AKIN and RIFLE criteria were 0.79 (95% confidence interval: 0.77 to 0.80) and 0.78 (95% confidence interval: 0.76 to 0.80), respectively (p = 0.369).

Conclusions

The AKIN and RIFLE criteria are accurate early predictors of mortality. The high incidence of cardiac surgery postoperative acute kidney injury should prompt the use of either AKIN or RIFLE criteria to identify patients at risk and to stimulate institutional measures that target acute kidney injury as a quality improvement initiative.

Section snippets

Patients and Methods

The Northern New England Cardiovascular Disease Study Group was founded in 1987 as a regional voluntary consortium capturing all of the coronary revascularizations and valve procedures in the northern New England area at eight medical centers in the states of Vermont, New Hampshire, and Maine. The group consists of clinicians, hospital administrators, and health care research personnel who seek to continuously improve the quality, safety, effectiveness, and cost of medical interventions in

Results

In general, the patient cohort was predominantly male, 71% had a history of hypertension, 88% had coronary artery disease, 73% had normal or near normal glomerular filtration rate, and 69% underwent CABG surgery alone (Table 2). Acute kidney injury developed in 7,391 patients (30%) using the AKIN criteria, and in 7,730 patients (31%) using the RIFLE criteria (Table 3). While the general classification was similar, the classification of the extent of injury appears to be different. Most patients

Comment

Our study compared the sensitivity and specificity of the AKIN and RIFLE classifications in assessing the presence of AKI and in predicting in-hospital mortality. We found similar rates of AKI as those previously reported by both the AKIN and RIFLE criteria. Additionally, there was no significant difference in prediction of in-hospital mortality between the two classifications. This is the largest study aimed at comparing the two classifications in cardiac surgery patients. However, we confirm

References (13)

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