Background
The high incidence of cardiac surgery-associated acute kidney injury (AKI) has significant consequences of increased mortality, need for dialysis, prolonged hospital stay, and increased hospital costs. The Acute Dialysis Quality Initiative Workgroup published the consensus Risk, Injury, Failure, Loss, and End-stage kidney disease (RIFLE) criteria, and the Acute Kidney Injury Network (AKIN) further developed the definition and stage classification of AKI. However, the ability of the RIFLE and AKIN classifications to predict postoperative mortality in patients undergoing cardiac surgery has not been well evaluated. We hypothesized that both the AKIN and RIFLE classifications could be used to predict in-hospital mortality.
Methods
Data were prospectively collected on 25,086 patients undergoing cardiac surgery in Northern New England from January 2001 to December 2007, excluding 339 patients on preoperative dialysis. AKIN and RIFLE criteria were used to classify patients postoperatively, using the last preoperative and the highest postoperative serum creatinine. We then compared the sensitivity and specificity of the RIFLE and AKIN criteria in predicting in-hospital mortality. The areas under the receiver operating characteristic curve (ROC) were calculated using logistic regression and tested for equality.
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