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01.12.2016 | Research article | Ausgabe 1/2016 Open Access

BMC Nephrology 1/2016

Predictive value of the RIFLE urine output criteria on contrast-induced nephropathy in critically ill patients

Zeitschrift:
BMC Nephrology > Ausgabe 1/2016
Autoren:
Aldjia Hocine, Pierre Defrance, Jacques Lalmand, Christian Delcour, Patrick Biston, Michaël Piagnerelli
Wichtige Hinweise

Competing interests

The authors declare that they have no competing interests.

Authors’ contributions

AH: conception and design, data collection and analysis, manuscript writing and final approval of the manuscript. PD: data collection and analysis, critical revision and final approval of the manuscript. JL: data collection, critical revision and final approval of the manuscript. CD: data collection, critical revision and final approval of the manuscript. PB: analysis, critical revision and final approval of the manuscript. MP: conception and design, data collection and analysis, manuscript writing, final approval of manuscript. All authors read and approved the final manuscript and meet the three authorship requirements.

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.
Literatur
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