RIFLE Classification and Mortality in Obstetric Patients Admitted to the Intensive Care Unit With Acute Kidney Injury: A 3-Year Prospective Study

• Published in: Reproductive sciences (Thousand Oaks, Calif.) Calif.), 2014-10, Vol.21 (10), p.1281-1287
• Main Authors: Kamal, Ebtesam M., Behery, Manal M. El, Sayed, Gamal Abbas El, Abdulatif, Howaida K.
• Format: Article
• Language: English
• Subjects: Acute Kidney Injury - diagnosis; Acute Kidney Injury - mortality; Acute Kidney Injury - therapy; Adult; Delivery, Obstetric - mortality; Embryology; Female; Hospital Mortality - trends; Humans; Intensive Care Units - trends; Kidney Failure, Chronic - diagnosis; Kidney Failure, Chronic - mortality; Kidney Failure, Chronic - therapy; Medicine & Public Health; Obstetrics/Perinatology/Midwifery; Original Article; Patient Admission - trends; Pregnancy; Prospective Studies; Reproductive Medicine; Risk Factors; Time Factors; Young Adult
• ISSN: 1933-7191; 1933-7205
• DOI: 10.1177/1933719114525277

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. Conclusion: 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.