Comparison of the accuracy of RIFLE, AKIN and KDIGO criteria in predicting early death after liver transplantation
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摘要:
目的 比较RIFLE、急性肾损伤网络（AKIN）和改善全球肾脏病预后组织（KDIGO）3个急性肾损伤（AKI）标准对肝移植受者术后早期（术后30 d）死亡的预测准确性。 方法 回顾性分析173例肝移植受者临床资料。根据RIFLE、AKIN和KDIGO 3个标准计算术后AKI发生率，分析术后30 d全因病死率及死因，应用二元Logistic回归分析术后30 d内死亡的危险因素，应用受试者工作特征（ROC）曲线比较3个标准对术后30 d内死亡的预测准确性。 结果 根据RIFLE、AKIN和KDIGO标准，术后AKI发生率分别为48.0%、51.4%和53.8%，术后30 d内死亡13例，病死率为7.5%。RIFLE、AKIN和KDIGO分期是术后30 d内死亡的独立危险因素（均为P < 0.05）。RIFLE、AKIN和KDIGO分期预测肝移植术后30 d内死亡的曲线下面积（AUC）分别为0.828、0.766和0.844，AKIN与KDIGO比较，差异有统计学意义（P < 0.05）。 结论 KDIGO标准对于肝移植受者术后早期死亡的预测能力更好。但作为工具，三者之间的比较选择尚需多中心大样本的证据支持。 -
关键词:
- 肝移植 /
- 急性肾损伤 /
- RIFLE标准 /
- 急性肾损伤网络（AKIN）标准 /
- 改善全球肾脏病预后组织（KDIGO）标准 /
- 病死率 /
- 终末期肝病模型
Abstract:Objective To compare the accuracy of three acute kidney injury (AKI) criteria of RIFLE, Acute Kidney Injury Network (AKIN) and Kidney Disease: Improving Global Outcomes (KDIGO) in predicting the early (30 d) postoperative death of liver transplant recipients. Methods Clinical data of 173 liver transplant recipients were retrospectively analyzed. The incidence of postoperative AKI was calculated according to the three criteria of RIFLE, AKIN and KDIGO. The all-cause fatality rate and cause of death at postoperative 30 d were analyzed. The risk factors of death within 30 d after operation were analyzed by binary Logistic regression. The prediction accuracy of three criteria for death within 30 d after operation was compared by the receiver operating characteristic (ROC) curve. Results According to the RIFLE, AKIN and KDIGO criteria, the incidences of postoperative AKI were 48.0%, 51.4% and 53.8%, respectively. Thirteen patients died within 30 d after operation and the fatality rate was 7.5%. RIFLE, AKIN and KDIGO stages were the independent risk factors for death within 30 d after operation (all P < 0.05). The area under the curve (AUC) of RIFLE, AKIN and KDIGO stages to predict death within 30 d after liver transplantation were 0.828, 0.766 and 0.844, respectively. There was a statistically significant difference between AKIN and KDIGO (P < 0.05). Conclusions KDIGO criterion is better for predicting early death after liver transplantation. However, as a tool, the comparative selection among these three criteria still needs the evidence support from a large multicenter sample. -
图 1 RIFLE、AKIN和KDIGO分期预测肝移植术后30 d内死亡的ROC曲线
Figure 1. ROC curves of RIFLE, AKIN and KDIGO staging for predicting death in 30 d after liver transplantation
表 1 RIFLE, AKIN和KDIGO关于AKI的诊断和分期标准
Table 1. Diagnostic and staging criteria of AKI by RIFLE, AKIN, and KDIGO
项目 诊断标准 分期标准 Risk或Ⅰ期 Injury或Ⅱ期 Failure或Ⅲ期 RIFLE
标准7 d内Scr①上升至≥1.5倍基线值 7 d内Scr上升至1.5倍基线值或GFR②下降 > 25% 7 d内Scr上升至2倍基线值或GFR下降 > 50% 7 d内Scr上升至3倍基线值或Scr > 354 μmol/L伴急增44 μmol/L或GFR下降 > 75% AKIN
标准48 h内Scr升高≥27 μmol/L或48 h内Scr上升至1.5倍基线值 48 h内Scr升高≥27 μmol/L或48 h内Scr上升至1.5~1.9倍基线值 48 h内Scr上升至2~3倍基线值 48 h内Scr上升至 > 3倍基线值或Scr≥354 μmol/L伴急增44 μmol/L或需肾脏替代治疗 KDIGO
标准48 h内Scr升高≥27 μmol/L或7 d内Scr上升至≥1.5倍基线值 48 h内Scr升高≥27 μmol/L或7 d内Scr上升至1.5~1.9倍基线值 7 d内Scr上升至2~3倍基线值 7 d内Scr上升至 > 3倍基线值或Scr≥354 μmol/L或需肾脏替代治疗 注：①Scr为血清肌酐。
②GFR为肾小球滤过率。
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表 2 肝移植术后30 d内死亡危险因素的多因素分析
Table 2. Multivariate analysis of risk factors for death in 30 d after liver transplantation
变量 OR① 95%CI② P值 RIFLE分期 4.514 1.945~10.473 0.000 AKIN分期 3.770 1.558~9.122 0.003 KDIGO分期 5.343 2.071~13.788 0.001 注：①OR为比值比。
②CI为可信区间。
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表 3 RIFLE、AKIN和KDIGO分期预测肝移植术后30 d内死亡的效能
Table 3. Effcacy of RIFLE, AKIN and KDIGO staging for predicting death in 30 d after liver transplantation
变量 AUC (95%CI①) 灵敏度 特异度 RIFLE分期 0.828 (0.763~0.881) 0.846 0.813 AKIN分期 0.766 (0.696~0.827) 0.923 0.519 KDIGO分期 0.844 (0.781~0.894)a 0.769 0.825 注：①CI为可信区间。
②与AKIN分期比较，aP < 0.05。
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[1] O'RIORDAN A, WONG V, MCQUILLAN R, et al. Acute renal disease, as defined by the RIFLE criteria, post-liver transplantation[J]. Am J Transplant, 2007, 7(1):168-176. http://cn.bing.com/academic/profile?id=b74aae94ac99ad03ecfbce6b53b5856e&encoded=0&v=paper_preview&mkt=zh-cn [2] BARRI YM, SANCHEZ EQ, JENNINGS LW, et al. Acute kidney injury following liver transplantation:definition and outcome[J]. Liver Transpl, 2009, 15(5):475-483. DOI: 10.1002/lt.21682. [3] HILMI IA, DAMIAN D, AL-KHAFAJI A, et al. Acute kidney injury following orthotopic liver transplantation:incidence, risk factors, and effects on patient and graft outcomes[J]. Br J Anaesth, 2015, 114(6):919-926. DOI: 10.1093/bja/aeu556. [4] FRALEY DS, BURR R, BERNARDINI J, et al. Impact of acute renal failure on mortality in end-stage liver disease with or without transplantation[J]. Kidney Int, 1998, 54(2):518-524. doi: 10.1046/j.1523-1755.1998.00004.x [5] VELIDEDEOGLU E, BLOOM RD, CRAWFORD MD, et al. Early kidney dysfunction post liver transplantation predicts late chronic kidney disease[J]. Transplantation, 2004, 77(4):553-556. doi: 10.1097/01.TP.0000114609.99558.41 [6] KARAPANAGIOTOU A, DIMITRIADIS C, PAPADOPOULOS S, et al. Comparison of RIFLE and AKIN criteria in the evaluation of the frequency of acute kidney injury in post-liver transplantation patients[J]. Transplant Proc, 2014, 46(9):3222-3227. DOI: 10.1016/j.transproceed.2014.09.161. [7] KOEZE J, KEUS F, DIEPERINK W, et al. Incidence, timing and outcome of AKI in critically ill patients varies with the definition used and the addition of urine output criteria[J]. BMC Nephrol, 2017, 18(1):70. DOI: 10.1186/s12882-017-0487-8. [8] TSAI TY, CHIEN H, TSAI FC, et al. Comparison of RIFLE, AKIN, and KDIGO classifications for assessing prognosis of patients on extracorporeal membrane oxygenation[J]. J Formos Med Assoc, 2017, 116(11):844-851. DOI: 10.1016/j.jfma.2017.08.004. [9] ERDOST HA, OZKARDESLER S, AKAN M, et al. Comparison of the RIFLE, AKIN, and KDIGO diagnostic classifications for acute renal injury in patients undergoing liver transplantation[J]. Transplant Proc, 2016, 48(6):2112-2118. DOI: 10.1016/j.transproceed.2016.03.044. [10] DURAND F, FRANCOZ C, ASRANI SK, et al. Acute kidney injury after liver transplantation[J]. Transplantation, 2018, 102(10):1636-1649. DOI: 10.1097/TP.0000000000002305. [11] MACDONALD AJ, NADIM MK, DURAND F, et al. Acute kidney injury in cirrhosis:implications for liver transplantation[J]. Curr Opin Crit Care, 2019, 25(2):171-178. DOI: 10.1097/MCC.0000000000000590. [12] NAHUM E, KADMON G, KAPLAN E, et al. Prevalence of acute kidney injury after liver transplantation in children:comparison of the pRIFLE, AKIN, and KDIGO criteria using corrected serum creatinine[J]. J Crit Care, 2019, 50:275-279. DOI: 10.1016/j.jcrc.2019.01.010. [13] KUNDAKCI A, PIRAT A, KOMURCU O, et al. Rifle criteria for acute kidney dysfunction following liver transplantation:incidence and risk factors[J]. Transplant Proc, 2010, 42(10):4171-4174. DOI: 10.1016/j.transproceed.2010.09.137. [14] UTSUMI M, UMEDA Y, SADAMORI H, et al. Risk factors for acute renal injury in living donor liver transplantation:evaluation of the RIFLE criteria[J]. Transpl Int, 2013, 26(8):842-852. DOI: 10.1111/tri.12138. [15] PARK MH, SHIM HS, KIM WH, et al. Clinical risk scoring models for prediction of acute kidney injury after living donor liver transplantation:a retrospective observational study[J]. PLoS One, 2015, 10(8):e0136230. DOI: 10.1371/journal.pone.0136230. [16] 王万里, 李青山, 周颖, 等.DCD供肝肝移植术后早期急性肾损伤相关危险因素分析[J].器官移植, 2018, 9(2):130-136. DOI: 10.3969/j.issn.1674-7445.2018.02.007.WANG WL, LI QS, ZHOU Y, et al. Analysis of risk factors of early acute kidney injury after liver transplantation from DCD donor liver[J]. Organ Transplant, 2018, 9(2):130-136. DOI: 10.3969/j.issn.1674-7445.2018.02.007. [17] TRINH E, ALAM A, TCHERVENKOV J, et al. Impact of acute kidney injury following liver transplantation on long-term outcomes[J]. Clin Transplant, 2017, 31(1). DOI: 10.1111/ctr.12863. [18] 张达利, 毕京峰, 高银杰, 等.肝移植术后患者急性肾损伤危险因素及严重程度分析[J].传染病信息, 2019, 32 (5):411-414. DOI: 10.3969/j.issn.1007-8134.2019.05.007.ZHANG DL, BI JF, GAO YJ, et al. Risk factors and severity of acute kidney injury in post-liver transplantation patients[J]. Infect Dis Inform, 2019, 32(5):411-414. DOI: 10.3969/j.issn.1007-8134.2019.05.007. [19] LEE HJ, KIM WH, JUNG CW, et al. Different severity of clinical outcomes between the 2 subgroups of stage 1 acute kidney injury after liver transplantation[J]. Transplantation, 2020. DOI: 10.1097/TP.0000000000003135[Epub ahead of print]. [20] ROY AK, MC GORRIAN C, TREACY C, et al. A comparison of traditional and novel definitions (RIFLE, AKIN, and KDIGO) of acute kidney injury for the prediction of outcomes in acute decompensated heart failure[J]. Cardiorenal Med, 2013, 3(1):26-37. DOI: 10.1159/000347037. [21] FUJII T, UCHINO S, TAKINAMI M, et al. Validation of the Kidney Disease Improving Global Outcomes criteria for AKI and comparison of three criteria in hospitalized patients[J]. Clin J Am Soc Nephrol, 2014, 9(5):848-854. DOI: 10.2215/CJN.09530913. [22] ZHOU J, LIU Y, TANG Y, et al. A comparison of RIFLE, AKIN, KDIGO, and Cys-C criteria for the definition of acute kidney injury in critically ill patients[J]. Int Urol Nephrol, 2016, 48(1):125-132. DOI: 10.1007/s11255-015-1150-6. [23] DE HAAN JE, HOORN EJ, DE GEUS HRH. Acute kidney injury after liver transplantation:recent insights and future perspectives[J]. Best Pract Res Clin Gastroenterol, 2017, 31(2):161-169. DOI: 10.1016/j.bpg.2017.03.004. [24] 庄焱, 谢青.肝衰竭并发急性肾损伤热点研究新进展[J].临床肝胆病杂志, 2018, 34(9):1836-1841. DOI: 10.3969/j.issn.1001-5256.2018.09.004.ZHUANG Y, XIE Q. Advances in research hotspots in liver failure complicated by acute kidney injury[J]. J Clin Hepatol, 2018, 34(9):1836-1841. DOI: 10.3969/j.issn.1001-5256.2018.09.004. [25] 王俊贤, 张素敏, 杨小兵.新型急性肾损伤生物标记物预测急性肾损伤发展及预后的研究进展[J].实用医学杂志, 2017, 33(15):2598-2600. DOI: 10.3969/j.issn.1006-5725.2017.15.045.WANG JX, ZHANG SM, YANG XB. Research progress of novel acute renal injury biomarkers for predicting the development and prognosis of acute renal injury[J]. J Pract Med, 2017, 33(15):2598-2600. DOI: 10.3969/j.issn.1006-5725.2017.15.045. -
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