Comparison Of KDIGO And AKIN Criteria In Critically Ill Patients With Acute Kidney Injury

Objective: To compare the diagnostic and prognostic value of KDIGO and AKIN criteria in patients with Acute Kidney Injury(AKI)in Intensive Care Unit(ICU).Methods: Retrospectively collected the case data of ICU inpatients from the First Affiliated Hospital of Nanhua University from January 1,2016 to December 31,2016,And patients who met the inclusion criteria and did not die during the ICU were followed up with death after three years as the observation endpoint.The data were analyzed using KDIGO and AKIN criteria,respectively.Results:1.The general data description results of KDIGO criteria and AKIN criteria showed gender,age,diabetes,basal creatinine value,Continuous Renal Replacement Therapy(CRRT),urinary protein,albumin,triglyceride,urea nitrogen,procalcitonin,ystatin C(CysC),serum potassium,PH,bicarbonate ion,systolic blood pressure,diastolic blood pressure and mean arterial pressure in ICU admission had statistically significant differences among groups with or without acute kidney injury(P<0.05).2.A total of 846 patient data were collected during the study period,of which 405 patients met the screening criteria.According to KDIGO criteria,202 patients(49.9%)were diagnosed with AKI,among which 57(14.1%)were stage 1,56(13.8%)were stage 2,and 89(22%)were stage 3.There were 194 patients(47.9%)diagnosed with AKI according to AKIN criteria,including 68 patients(16.8%)in stage 1,57 patients(14.1%)in stage 2,and 69 patients(17.0%)in stage 3.The difference between KDIGO criteria and AKIN criteria in the diagnosis of AKI was statistically significant(P <0.05).3.The Kappa value of the consistency measure between KDIGO standard and AKIN standard is 0.887,and the difference is statistically significant(P <0.05).4.Regardless of the KDIGO criteria or AKIN criteria,Acute Physiology And Chronic Health Evaluation(APACHE II)And Sequential Organ ⅡFailure Score(SOFA)in Acute kidney injury comparative differences between groups were statistically significant(P < 0.05),And the area under SOFA score curve is larger than that under APACHEII score curve.5.Among patients with AKI diagnosed by KDIGO and AKIN criteria,patients who require CRRT treatment have longer ICU stays and higher mortality than patients who do not require CRRT treatment.6.The total number of ICU deaths was 77(19%).According to the KDIGO criteria,52 cases(25.7%)died of AKI and 25 cases(12.3%)died of non-AKI,the difference was statistically significant(P < 0.05).Aaccording to the AKIN criteria,there were 47 AKI deaths(24.2%)and 30 non-AKI deaths(14.2%),with statistically significant differences(P < 0.05).The comparison of the in-hospital mortality of AKI diagnosed by KDIGO and AKIN criteria showed that the difference was not statistically significant(P> 0.05).7.ROC analysis of AKI in-hospital mortality diagnosed by KDIGO criteria and AKIN criteria found that the AUC area of KDIGO criteria: 0.680(95% CI 0.606-0.753,P <0.05),and the AUC area of AKIN criteria: 0.610(95% CI 0.537-0.684,P <0.05),AKI diagnosed by both criteria can predict in-hospital death,but AKI diagnosed by KDIGO criteria has higher predictive value of in-hospital death than AKI diagnosed by AKIN criteria.8.A total of 328 patients participated in the follow-up,of whom 126 were lost to follow-up(38.4%),and 112 patients died(34.1%).According to the analysis of KDIGO criteria,53 cases of AKI died(36.1%).According to the analysis of AKIN criteria,53 cases of AKI died(36.1%).Comparison of three-year mortality rate of AKI diagnosed by KDIGO and AKIN criteria showed no significant difference.(P> 0.05),and AKI diagnosed by KDIGO and AKIN criteria is not suitable for predicting the three years mortality rate(P> 0.05).Conclusion: 1.KDIGO criteria is more sensitive than AKIN criteria in diagnosing the occurrence of AKI.2.Whether it is the KDIGO standard or the AKIN standard,the SOFA score is more accurate than the APACHE II score in predicting the occurrence of AKI.3.Among AKI patients diagnosed by KDIGO criteria and AKIN criteria,patients who require CRRT treatment have longer ICU hospitalization and higher mortality.4.AKI diagnosed by KDIGO criteria and AKIN criteria may predict in-hospital mortality,but neither can predict three-year mortality.