Acute Kidney Injury in Patients with Hemorrhagic Fever with Renal Syndrome Caused by Hantaan Virus: Comparative Evaluation by RIFLE and AKIN Criteria

Acute kidney injury (AKI) is one of the most prominent characteristics of hemorrhagic fever with renal syndrome (HFRS) caused by Hantaan virus. The present study evaluated the incidence and severity of AKI classified by both the RIFLE and AKIN criteria in 120 HFRS patients at 48 h and 1 week of the patient admission. The agreements between RIFLE and AKIN and RIFLE and AKIN defined by serum creatinine (AKINc and RIFLEc) were examined by Kappa statistics. AKI occurred in 79.2% and 82.5% at 48 h and in 84.2% and 89.2% at 1 week of admission by RIFLE and AKIN criteria, respectively. RIFLE and AKIN showed very good agreement in classifying AKI at 48 h and 1 week of admission (kappa > 0.900). RIFLE and RIFLEc and AKIN and AKINc at 48 h and 1 week of admission had almost perfect agreement (kappa > 0.900). The classifications of RIFLE and RIFLEc and AKIN and AKINc at 48 h and 1 week were in good agreement (kappa > 0.650). AKI classifications by RIFLE and AKIN were associated with mortality, occurrence of complications, and length of hospital stay. We conclude that AKI occurs in nearly 90% of HFRS patients during the disease course. RIFLE and AKIN classify AKI in HFRS with similar sensitivity. RIFLEc and AKINc may be used as alternatives of standard RIFLE and AKIN in the settings of general wards. The AKI classifications defined at 48 h of admission have predictive value for HFRS disease progression and severity.