目的:本研究旨在评估风险的相关性,损伤,失败,损失,和终末期肾功能衰竭(RIFLE)分类与重症监护病房(ICU)产科患者的住院死亡率,并评估急性肾损伤(AKI)与其他危险因素的关系。
方法:RIFLE的4个阶段(非急性肾衰竭,风险,损伤,和失败)得分从0到3分,分别。将RIFLE评分的预后表现与一般ICU模型进行比较。
结果:30例(5.88%)ICU患者发生AKI。AKI的主要原因是溶血,肝酶升高,低血小板综合征13(43%),妊娠相关高血压9(30%),产褥期败血症3(10%),胎盘早剥2(6.6%),播散性血管内凝血病2(6.6%),麻醉并发症1(3.3%)。根据rifle标准,患者被分类为风险(3.3%),伤害(16.6%),失败(33.3%),和亏损(46.6%)。在51例(10%)病例中,因ICU入院而导致的孕产妇死亡。这16例(31.3%)是由AKI引起的。与死亡率相关的独立危险因素是高胆红素血症,低水平的HCO3和RIFLE。根据RIFLE评分的ICU患者的受试者-操作者特征曲线显示曲线下面积=0.824。
结论:RIFLE分类系统可以预测产科ICU患者AKI的死亡风险,且死亡率与高RIFLE等级呈正相关。
OBJECTIVE: This
study is to assess the correlation of risk, injury, failure, loss, and end-stage renal failure (
RIFLE) classification with hospital mortality in intensive care unit (ICU) obstetric patients and to evaluate the relation of acute kidney injury (AKI) to other risk factors.
METHODS: The 4 stages of
RIFLE (nonacute renal failure, risk, injury, and failure) were scored from 0 to 3 points, respectively. The prognostic performance of the
RIFLE score was compared to the general ICU models.
RESULTS: AKI occurred in 30 (5.88%) of patients admitted to ICU. The main causes of AKI were hemolysis, elevated liver enzymes, and low platelet syndrome 13 (43%), pregnancy-related hypertension 9 (30%), puerperal sepsis 3 (10%), abruption placentae 2 (6.6%), disseminated intravascular coagulopathy 2 (6.6%), and anesthetic complications 1 (3.3%). According to the RIFLE criteria, patients were classified into Risk (3.3%), Injury (16.6%), Failure (33.3%), and Loss (46.6%). Maternal mortality from total ICU admission occurred in 51 (10%) cases, of these 16 (31.3%) cases were due to AKI. Independent risk factors associated with mortality were hyperbilirubinemia, low levels of HCO3, and RIFLE. Receiver-operator characteristic curves for ICU patients according to RIFLE score showed area under the curve = 0.824.
CONCLUSIONS: The RIFLE classification system could predict the risk of mortality from AKI in obstetric ICU patients and mortality was positively associated with high
RIFLE classes.