Abstract
Acute kidney injury (AKI) is a significant complication after hematopoietic stem cell
transplantation (HSCT) and frequently limits treatment success. Patients suffering
complications with AKI often have high mortality. This investigation analyzed the
outcomes of patients receiving allogeneic HSCT and identified the association between
prognosis and RIFLE (risk of renal failure, injury to kidney, failure of kidney function,
loss of kidney function and end-stage renal disease) classification. This study reviewed
the medical records of 101 patients receiving allogeneic HSCT during an 8-year period
at a specialized hematology ward in a university hospital in Taiwan. Demographic,
clinical and laboratory variables were retrospectively gathered as predicators. Overall
6-month mortality was 36.6% (37/101). Mortality progressively and significantly increased
(χ2 for trend, P<0.001) based on RIFLE classification severity. Multiple variable Cox regression analysis
identified maximum RIFLE score on day 7 to 14 post-HSCT, occurrence of hepatic veno-occlusive
disease and respiratory failure during admission as independent risk factors for 6-month
mortality. Using the area under the receiver operating characteristic curve, the RIFLE
classification on day 7 to 14 post-HSCT has the best discriminative power (area under
the receiver operating characteristic curve: 0.696±0.057, P<0.001) compared with day 0 to 7, 14 to 30 and 30 to 60 post-HSCT. Cumulative survival
rates at 6-month follow-up differed significantly (P<0.05) among non-AKI, RIFLE-R versus RIFLE-I and RIFLE-F. Hepatic veno-occlusive disease,
respiratory failure and severity of maximum RIFLE score on day 7 to 14 post-HSCT were
independent predictors for 6-month mortality. RIFLE classification on day 7 to 14
post-HSCT can improve the accuracy of 6-month mortality in patients who received allogeneic
HSCT.
Key Indexing Terms
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REFERENCES
- Hematopoietic stem-cell transplantation.N Engl J Med. 2006; 354: 1813-1826
- Acute renal failure after allogeneic myeloablative stem cell transplantation: retrospective analysis of incidence, risk factors and survival.Bone Marrow Transplant. 2007; 39: 359-365
- Acute renal failure in hematopoietic cell transplantation.Kidney Int. 2006; 69: 430-435
- Impact of acute kidney injury on long-term mortality after nonmyeloablative hematopoietic cell transplantation.Biol Blood Marrow Transplant. 2008; 14: 309-315
- Acute renal failure independently predicts mortality after myeloablative allogeneic hematopoietic cell transplant.Kidney Int. 2005; 67: 1999-2005
- Renal dysfunction in allogeneic hematopoietic cell transplantation.Kidney Int. 2002; 62: 566-573
- A comparative assessment of the RIFLE, AKIN and conventional criteria for acute kidney injury after hematopoietic SCT.Bone Marrow Transplant. 2010; 45: 1427-1434
- Acute renal failure.Lancet. 2005; 365: 417-430
- Acute dialysis quality initiative workgroup: acute renal failure—definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group.Crit Care. 2004; 8: R204-R212
- RIFLE classification is predictive of short-term prognosis in critically ill patients with acute renal failure supported by extracorporeal membrane oxygenation.Nephrol Dial Transplant. 2006; 21: 2867-2873
- RIFLE classification can predict short-term prognosis in critically ill cirrhotic patients.Intensive Care Med. 2007; 33: 1921-1930
- RIFLE classification for predicting in-hospital mortality in critically ill sepsis patients.Shock. 2009; 31: 139-145
- The RIFLE score increases the accuracy of outcome prediction in patients with acute respiratory distress syndrome undergoing open lung biopsy.Respiration. 2009; 77: 398-406
- Acute kidney injury in the intensive care unit according to RIFLE.Crit Care Med. 2007; 35: 1837-1843
- A multi-centre evaluation of the Rifle criteria for early acute kidney injury in critically ill patients.Nephrol Dial Transplant. 2008; 23: 1203-1210
- Veno-occlusive disease of the liver after bone marrow transplantation: diagnosis, incidence, and predisposing factors.Hepatology. 1984; 4: 116-122
- Organ system failure scoring system can predict hospital mortality in critically ill cirrhotic patients.J Clin Gastroenterol. 2003; 37: 251-257
- National Institutes of Health consensus development project on criteria for clinical trials in chronic graft-versus-host disease: I.Diagnosis and staging working group report. Biol Blood Marrow Transplant. 2005; 11: 945-956
- IBMTR Severity Index for grading acute graft-versus-host disease: retrospective comparison with Glucksberg grade.Br J Haematol. 1997; 97: 855-864
- American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference: definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis.Crit Care Med. 1992; 20: 864-874
- Critical care of the hematopoietic stem cell transplant recipient.Crit Care Clin. 2010; 26: 133-150
- A comparison of allogeneic and autologous bone marrow transplantation for lymphoblastic lymphoma.Blood. 2002; 101: 2476-2482
- Acute renal failure following bone marrow transplantation: a retrospective study of 272 patients.Am J Kidney Dis. 1989; 13: 210-216
- Acute renal failure after myeloablative hematopoietic cell transplant: incidence and risk factors.Kidney Int. 2005; 67: 272-277
- Acute renal failure in patients following bone marrow transplantation: prevalence, risk factors and outcome.Am J Nephrol. 1995; 15: 473-479
- Hepatic veno-occlusive disease (sinusoidal obstruction syndrome) after hematopoietic stem cell transplantation.Mayo Clinic Proc. 2003; 78: 589-598
- Incidence and outcome of hepatic veno-occlusive disease after blood or marrow transplantation: a prospective cohort study of the European Group for Blood and Marrow Transplantation.Blood. 1998; 92: 3599-3604
- Veno-occlusive disease of the liver and multiorgan failure after bone marrow transplantation: a cohort study of 355 patients.Ann Intern Med. 1993; 118: 255-267
- Long-term survival from respiratory failure after marrow transplantation for malignancy.Am Rev Respir Dis. 1992; 145: 510-514
- Outcome of hematopoietic stem cell recipients who were mechanically ventilated and admitted to intensive care units.J Formos Med Assoc. 2007; 106: 295-301
- Outcome of bone marrow transplantation patients requiring mechanical ventilation.Crit Care Med. 2000; 28: 1014-1017
Article info
Publication history
Accepted:
January 23,
2012
Received:
December 13,
2011
Footnotes
The first 3 authors contributed equally to this work.
Identification
Copyright
© 2013 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.
