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RIFLE has been shown to be the most sensitive method for detecting AKI early in its course and is useful for prognostic purposes (Table 21-2).29 fte first sign of impending renal failure is oliguria, defined in adults as less than 0.5 mL/kg/ hr or less than 400 mL per day or, less commonly, a sudden increase in serum creatinine.
TABLE 21-2 RIFLE Criteria (Creatinine and Urine Output Indicators) Risk Increased serum creatinine × 1.5 UOP 25% Injury Increased serum creatinine × 2 UOP 50% 12 hr Failure Increased serum creatinine × 3 UOP 75% 24 hr or anuria × 12 hr Loss Persistent ARF, complete loss of kidney function >4 wk ESRD ESRD, complete loss of kidney function >3 mo ARF, acute renal failure; ESRD, end-stage renal disease
;Similar to renal failure, liver failure is a complex and far-reaching condi- tion because it entails management of diverse problems such as fluid shifts, coagulopathy, portal hypertension, hepatic encepha- lopathy, and hepatorenal syndrome, but in contrast to renal failure, there is no "liver dialysis" to support the patient.
More than 30 years ago, a landmark article examining the relationship between cirrhosis, abdominal surgery, and outcomes demon- strated mortality rates approaching 80% in patients with cirrhosis and a prothrombin time more than 2.5 seconds longer than in control subjects who underwent cholecystectomy. ftese fatalities were attributable to intra-abdominal hemorrhage, progressive hepatic and renal failure, and upper gastrointestinal hemorrhage resulting from portal hypertension.
However in contrast to renal failure, which is well defined by the RIFLE cri- teria, there is no true formal definition or grading of postoperative liver failure.
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