Acute kidney injury and its progression in hospitalized patients-Results from a retrospective multicentre cohort study with a digital decision support system.

Thea Sophie Kister,Berend Isermann,Markus Wehner,Jörg Michael Telle,Martin Federbusch,Johannes Remmler,Thorsten Kaiser,Alexander Kehrer,Uwe Krause,Heike Richter,Jan Halbritter,Carina Cundius,Felix Eckelt,Maria Schmidt,Markus Voigt,Bhagwan Dass

doi:10.1371/journal.pone.0254608

Thea Sophie Kister, Berend Isermann + Show 14 more

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https://doi.org/10.1371/journal.pone.0254608

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Journal: PloS one	Publication Date: Jul 12, 2021
Citations: 9	License type: CC BY 4.0

Affiliation: Leipzig University

Abstract

In this retrospective multicentric cohort study, we evaluate the potential benefits of a clinical decision support system (CDSS) for the automated detection of Acute kidney injury (AKI). A total of 80,389 cases, hospitalized from 2017 to 2019 at a tertiary care hospital (University of Leipzig Medical Center (ULMC)) and two primary care hospitals (Muldentalkliniken (MTL)) in Germany, were enrolled. AKI was defined and staged according to the Kidney disease: improving global outcomes (KDIGO) guidelines. Clinical and laboratory data was automatically collected from electronic patient records using the frameworks of the CDSS. In our cohort, we found an overall AKI incidence proportion of 12.1%. We identified 6,393/1,703/1,604 cases as AKI stage 1/2/3 (8.0%/2.1%/2.0%, respectively). Administrative coding with N17 (ICD-10-GM) was missing in 55.8% of all AKI cases with the potential for additional diagnosis related groups (DRG) reimbursement of 1,204,200 € in our study. AKI was associated with higher hospital mortality, increased length of hospitalisation and more frequent need of renal replacement therapy. A total of 19.1% of AKI cases (n = 1,848) showed progression to higher AKI stages (progressive AKI) during hospitalization. These cases presented with considerably longer hospitalization, higher rates of renal replacement therapy and increased mortality (p<0.001, respectively). Furthermore, progressive AKI was significantly associated with sepsis, shock, liver cirrhosis, myocardial infarction, and cardiac insufficiency. AKI, and especially its progression during hospitalization, is strongly associated with adverse outcomes. Our automated CDSS enables timely detection and bears potential to improve AKI outcomes, notably in cases of progressive AKI.

Highlights

Acute kidney injury (AKI) is a common and serious clinical event that affects up to 15.0% of all hospitalized and up to 50.0% intensive care unit patients [1]
In studies using definitions conforming to the Kidney disease: improving global outcomes criteria (KDIGO), the pooled rate of AKI was 23.2% worldwide, and the AKI-associated mortality was 23.0% [2]
AKI is associated with an increased short- and long-term mortality, as well as the development of chronic kidney disease (CKD) [3]

Summary

Introduction

Acute kidney injury (AKI) is a common and serious clinical event that affects up to 15.0% of all hospitalized and up to 50.0% intensive care unit patients [1]. In studies using definitions conforming to the Kidney disease: improving global outcomes criteria (KDIGO), the pooled rate of AKI was 23.2% worldwide, and the AKI-associated mortality was 23.0% [2]. AKI is associated with an increased short- and long-term mortality, as well as the development of chronic kidney disease (CKD) [3]. According to the KDIGO Clinical Practice Guidelines, AKI is defined by an increased serum creatinine (SCr) and/or reduced urine output, separated into three different stages of severity (Table 1) [5]. Even an increase of only 26.5 μmol/l in SCr (AKI stage 1) is correlated with a significant risk of mortality and morbidity [6], requiring determination of the underlying cause in a timely manner. Due to the complexity of the AKI definition, diagnosis could be delayed or even overlooked

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