The Application Of RIFLE Criteria In Patients With MODS Complicated By AKI In Need For CRRT

Objective To investigate the prognosis of patients with multiple dysfunction syndrome(MODS)using continuous renal replacement therapy for the treatment of their acute kidney injury(AKI)in different everity. Uniwariate and multivariate analysis were performed to identify risk factors associated with patients with MODS treated by CRRT.Methods We retrospective studied 184 patients with MODS treated with continuous veno-venous hemofiltration(CWH)in the period of Jan.2004 to Aug.2008.The severity of AKI in these paients was classified as AKI of phase I, II and III according to the RIFLE criteria. The mortality rate in ICU and the number of failed organs were also compared among patients with different severity of AKI. Their APACHE II score,sequential organ failure assessment (SOFA) score ,MODS score, mean arteral pressure,oxygenate index,blood urea nitrgen and serum creatinine ect.were also compared before CVVH between the nonsurvivors and surviors.Results①The overall mortality rate in ICU was 54.3%.The rate in patients with AKI of phase I was 44.4%.The rate of phase II was 63.6%,and the rate of phase III was 54.7%.There were no significant differences according to RIFLE classification.②The number of failed organs has nothing to do with AKI in different everity. The more failed organs,the higher mortality rate in ICU. Patients presenting =4 failed organs had higher mortality rate in hospital than those showing=3 failed organs(68.9% vs 14.3 %,p=0.000).③Age,mean arterial pressure,APACHE II score,MODS score,SOFA score,the dosage of dopamine,the number of failed organs,lactic acid in nonsurvivors were higher than those in survivors .The differences were significant. And there were significant differences in the ratios of sex,mechanical ventilation,vasopressors and hospital- acquired AKI between the two groups.④Multivariate analysis identified the following risk factors: APACHEⅡscore(>20) (OR=5.639, 95%CI1.444-22.022),number of failed organs (=4个) (OR=10.671, 95%CI3.841-29.644),the need of vasoactive drug(OR=7.744 , 95%CI2.450-24.472), hospital- acquired AKI(OR=3.030, 95%CI1.321-6.950). Univariate analysis identified that age (> 60 years) (OR=2.03,95%CI为1.12-3.66)was risk factor too.Conclusions①The RIFLE classification could predict the prognosis in patients with MODS complicated by AKI in need for CRRT in some degree.②CRRT could improve the prognosis of MODS in early phase. ?The risk factors were APACHE II score (>20),number of failed organs(=4),the need of vasoactive drug,hospital-acquired AKI and age(>60). prevention of risk factors may play a key role in the reduction of mortality in critically ill patients.