NDT Advance Access originally published online on July 31, 2006
Nephrology Dialysis Transplantation 2007 22(1):285; doi:10.1093/ndt/gfl468
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An assessment of the rifle criteria for acute renal failure in severely burned patients
Email: jalopes93{at}hotmail.comSir,
RIFLE is a newly developed classification for acute renal failure (ARF) that defines three grades of severity—Risk (class R), Injury (class I) and Failure (class F) [1]. Although some studies have applied this scoring system in sets of critically ill patients [2–4], its usefulness in patients with severe burns has not yet been assessed. We sought to determine retrospectively the ability of RIFLE classification to predict mortality in severely burned patients admitted to the Burns Unit of our Hospital between January 2004 and December 2005. Patients were categorized on serum creatinine or urinary output, or both and the criteria that led to the worst classification were used. A total of 126 patients (83 men; mean age: 49.44 ± 19.23 years; 123 Caucasian; 10 diabetic) were evaluated. According to the RIFLE criteria, 14.3% of all the patients were in the class R for ARF, 8.7% in the class I and 12.7% in the class F. In all the cases, the maximum RIFLE occurred within the first 10 days of hospitalization in the Burns Unit. Patients with worst renal function were older (Normal renal function, 46 ± 19.2 years; class R, 44.3 ± 21.71 years; class I, 59 ± 17.3 years; and class F, 60.1 ± 18.5 years; P = 0.014), and had a higher burned body surface (Normal renal function, 16.3 ± 13.4%; class R, 28.4 ± 25.1%; class I, 52.3 ± 27.4%; and class F, 41.3 ± 28.9%; P < 0.0001), but did not differ in terms of comorbidity, namely cardiovascular disease and diabetes mellitus. In addition, males were more prevalent in this set of patients. Mortality rate was 17.5% and increased significantly from Normal to class F (Normal, 6%; class R, 11.1%; class I, 63.6%; and class F, 75%; P < 0.0001). Forward stepwise multivariate regression analysis showed that age, burned body surface and RIFLE class were independent predictors of mortality. Class R (odds ratio 5.6, 95% CI 1.2–26.8, P < 0.0001) and class I (odds ratio 6.2, 95% CI 1.1–47.8, P = 0.008) were associated with a significantly higher risk of death than normal renal function. In sum, RIFLE criteria allowed to identify close to 36% of severely burned patients as having various degrees of ARF and seems an important tool to stratify these patients according to risk of death.
Conflict of interest statement. None declared.
1Department of Nephrology and
Renal Transplantation
2Department of Plastic
Surgery and Burns Unit
Hospital de Santa Maria
Lisboa
Portugal
References
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- Bell M, Liljestam E, Granath F, Fryckstedt J, Ekbom A, Martling CR. (2005) Optimal follow-up time after continuous renal replacement therapy in acute renal failure patients stratified with the RIFLE criteria. Nephrol Dial Transplant 20:354–360.
[Abstract/Free Full Text] - Kuitunen A, Vento A, Suojaranta-Ylinen R, Pettila V. (2006) Acute renal failure after cardiac surgery: evaluation of the RIFLE classification. Ann Thorac Surg 81:542–546.
[Abstract/Free Full Text] - Hoste EA, Clermont G, Kersten A, et al. (2006) RIFLE criteria for acute kidney injury are associated with hospital mortality in critically ill patients: a cohort analysis. Crit Care 10:R73.[CrossRef][Medline]
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