Acute Kidney Injury In Chinese Patients:Comparison Between Acute Kidney Injury Network Creatinine Criteria And Urine Output Criteria

Objective:The aim of the study was to evaluate the diagnostic and prognostic value of Acute Kidney Injury Network (AKIN] creatinine (Cr) criteria and urine output (UO) criteria for acute kidney injury (AKI) in critically ill patients in Mainland China.Design:A multicenter retrospective cohort studySetting:22tertiary intensive care units (ICUs) in ChinaPatients:Patients (≥18years) admitted from July1,2009to August30,2009without evidence of end-stage renal disease, who had an ICU length of stay more than48hours and more than2creatinine measurements.Intervention:We performed a secondary data analysis of the database of China Critical Care Clinical Trial Group (CCCCTG). Demographic information, underlying disease, diagnostic information, lab and physiological data, interventions during the ICU stay and patient outcomes were collected. AKI was diagnosed based on AKIN Cr and UO criteria, without consideration of renal replacement therapy. All patients were further classified into4groups, i.e. those without AKI, those with maximum AKI classification by Cr criteria (Group A), those with maximum AKI classification by both Cr and UO criteria (Group B), and those with maximum AKI classification by UO criteria (Group C). Risk factors were compared with multivariate logistic regression analysis. Patient survival rates in4groups were compared with Kaplan-Meier curve.Results:From3063adult patient records in the CCCCTG database,938patients were included in final analysis. Three hundred and sixty-one patients (38.5%) developed AKI, with hospital mortality of33.8%. The hospital mortality rate was24.8%in Group A,50.0%in Group B, and54.1%in Group C, respectively, which was significantly higher than that in non-AKI group (15.1%, p<0.001). Multivariate logistic regression analysis showed that patients in Group B and Group C, but not Group A, were associated with a significant higher risk of hospital mortality as compared with non-AKI patients, with OR1.353(95%CI0.901-2.033, p=0.145] for Group A,2.783(95%CI1.488-5.221, p=0.001] for Group B, and4.057(95%CI2.199-7.484, p<0.001) for Group C. The Kaplan-Meier curve clearly showed that the mortality of Group B and Group C were significantly higher than Group A and non-AKI group.Conclusion:UO criteria could improve the sensitivity of AKI diagnosis and predict increased severity, maybe superior to the Cr criteria in predicting hospital mortality.