Understanding Electronic AKI Alerts: Characterization by Definitional Rules
| Autor: | John D. Williams, Soma Meran, Aled O. Phillips, Jennifer Holmes, Gethin Roberts |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2017 |
| Předmět: |
medicine.medical_specialty
030232 urology & nephrology electronic alerts urologic and male genital diseases lcsh:RC870-923 03 medical and health sciences chemistry.chemical_compound 0302 clinical medicine Clinical Research Internal medicine medicine 030212 general & internal medicine Intensive care medicine Normal range Creatinine business.industry Acute kidney injury medicine.disease lcsh:Diseases of the genitourinary system. Urology female genital diseases and pregnancy complications chemistry acute kidney injury Nephrology outcome business Kidney disease |
| Zdroj: | Kidney International Reports, Vol 2, Iss 3, Pp 342-349 (2017) Kidney International Reports |
| ISSN: | 2468-0249 |
| Popis: | Introduction Automated acute kidney injury (AKI) electronic alerts are based on comparing creatinine with historic results. Methods We report the significance of AKI defined by 3 “rules” differing in the time period from which the baseline creatinine is obtained, and AKI with creatinine within the normal range. Results A total of 47,090 incident episodes of AKI occurred between November 2013 and April 2016. Rule 1 (>26 μmol/l increase in creatinine within 48 hours) accounted for 9.6%. Rule 2 (≥50% increase in creatinine within previous 7 days) and rule 3 (≥50% creatinine increase from the median value of results within the last 8–365 days) accounted for 27.3% and 63.1%, respectively. Hospital-acquired AKI was predominantly identified by rules 1 and 2 (71.7%), and community-acquired AKI (86.3%) by rule 3. Stages 2 and 3 were detected by rules 2 and 3. Ninety-day mortality was higher in AKI rule 2 (32.4%) than rule 1 (28.3%, P < 0.001) and rule 3 (26.6%, P < 0.001). Nonrecovery of renal function (90 days) was lower for rule 1 (7.9%) than rule 2 (22.4%, P < 0.001) and rule 3 (16.5%, P < 0.001). We found that 19.2% of AKI occurred with creatinine values within normal range, in which mortality was lower than that in AKI detected by a creatinine value outside the reference range (22.6% vs. 29.6%, P < 0.001). Discussion Rule 1 could only be invoked for stage 1 alerts and was associated with acute on chronic kidney disease acquired in hospital. Rule 2 was also associated with hospital-acquired AKI and had the highest mortality and nonrecovery. Rule 3 was the commonest cause of an alert and was associated with community-acquired AKI. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|