• Manuel E Herrera-Gutiérrez, Gemma Seller-Pérez, Esther Banderas-Bravo, Cesar Aragón-Gonzalez, Rebeca Olalla-Sánchez, and Rosario Lozano-Sáez.
• Critical Care and Emergency Unit, University Hospital Carlos Haya, Malaga, 29010, Spain. mehguci@gmail.com
• J Crit Care. 2011 Dec 1;26(6):572-6.

PurposeWe hypothesized that RIFLE based on creatinine clearance (CrCl) is superior to that based on serum creatinine (sCr) or Cockroft-Gault (C-G) because it is an earlier marker of kidney dysfunction.Materials And MethodsAt day 3 of admission, we compared the RIFLE based on sCr, C-G, and CrCl with 28-day mortality and development of RIFLE-F during intensive care unit stay.ResultsPercentages in the RIFLE levels were similar for the 3 estimates, but the patients included in each level were different; with CrCl as the reference, κ statistic was 0.29 (95% confidence interval, 0.15-0.43) for sCr and 0.21 (0.07-0.36) for C-G. Mortality at day 28 was 19.3%, with percentages of mortality increasing with RIFLE based in CrCl but not sCr or C-G (area under the curve, 0.57 [45-72] for C-G; 0.57 [44-72] for sCr; and 0.64 [52-79] for CrCl). Logistic regression only showed an independent relationship with mortality for RIFLE measured with CrCl.ConclusionsRIFLE classification using sCr or C-G at the third day of admission predicts outcome less accurately than with the use of CrCl. Because of the delay in the rise of sCr after a sudden glomerular filtration rate decrease, RIFLE based in CrCl may represent an advantage in terms of precocity.Copyright © 2011 Elsevier Inc. All rights reserved.

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