The role of an electronic alert system to detect acute kidney injury in hospitalized patients: DETECT-H Project.

Autor:	Labrador Gómez PJ; Department of Nephrology, University Hospital Complex of Cáceres, Cáceres, Spain. Electronic address: pjlabrador@yahoo.es., González Sanchidrián S; Department of Nephrology, University Hospital Complex of Cáceres, Cáceres, Spain; International Renal Research Institute of Vicenza (IRRIV), Vicenza, Italy., Labrador Gómez J; Department of Hematology, University Hospital of Burgos, Burgos, Spain., Gómez-Martino Arroyo JR; Department of Nephrology, University Hospital Complex of Cáceres, Cáceres, Spain., Jiménez Herrero MC; Department of Hematology, University Hospital of Burgos, Burgos, Spain., Polanco Candelario SJA; Department of Nephrology, University Hospital Complex of Cáceres, Cáceres, Spain., Marín Álvarez JP; Department of Nephrology, University Hospital Complex of Cáceres, Cáceres, Spain., Gallego Domínguez S; Department of Nephrology, University Hospital Complex of Cáceres, Cáceres, Spain., Davin Carrero E; Department of Nephrology, University Hospital Complex of Cáceres, Cáceres, Spain., Sánchez Montalbán JM; Department of Nephrology, University Hospital Complex of Cáceres, Cáceres, Spain., Castellano Cerviño I; Department of Nephrology, University Hospital Complex of Cáceres, Cáceres, Spain., Rosner MH; Department of Medicine, Division of Nephrology, University of Virginia Health System, Charlottesville, VA, USA., Ronco C; International Renal Research Institute of Vicenza (IRRIV), Vicenza, Italy; Department of Nephrology Dialysis & Transplantation, San Bortolo Hospital, Vicenza, Italy.
Jazyk:	English; Spanish; Castilian
Zdroj:	Nefrologia [Nefrologia (Engl Ed)] 2019 Jul - Aug; Vol. 39 (4), pp. 379-387. Date of Electronic Publication: 2018 Dec 14.
DOI:	10.1016/j.nefro.2018.08.011
Abstrakt:	Background and Aims: Acute kidney injury (AKI) is associated with higher mortality and length of stay (LOS) for hospitalized patients. To improve outcomes, an electronic detection system could be a useful tool for early diagnosis. Methods: A fully automated real-time system for detecting decreased glomerular filtration rate in adult patients was developed in our hospital, DETECT-H project. AKI was established according to KDIGO guidelines. Results: In six months, 1241 alerts from 11,022 admissions were issued. Overall incidence of AKI was 7.7%. Highest AKI stage reached was: stage 1 (49.8%), 2 (24.5%) and 3 (25.8%), in-hospital mortality was 10.9%, 22.7%, 33.9% respectively and 57.1% in AKI requiring dialysis; mortality in stable CKD was 4.3%. Median LOS was 8 days versus 5 days for all patients. AKI was associated with a mortality of 3.18 (95% CI 1.80-5.59) and a LOS 1.52 (1.11-2.08) times as high as that for admissions without AKI. Multivariate analysis indicated that a LOS higher than 8 days was associated with AKI. Previous CKD was noted in 31.9% and AKI in 45.3% at discharge. As compared to the use of the detect system, only one third of CKD patients and half of AKI episodes were identified. Conclusions: CKD and in-hospital AKI are under-recognized entities. Mortality and LOS are increased in-hospital patients with renal dysfunction. AKI severity was associated with higher mortality and LOS. An automated electronic detection system for identifying renal dysfunction would be a useful tool to improve renal outcomes. (Copyright © 2018 Sociedad Española de Nefrología. Published by Elsevier España, S.L.U. All rights reserved.)
Databáze:	MEDLINE
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