Abstract
BackgroundCommunity-acquired acute kidney injury (CA-AKI)-associated hospitalizations impose significant health care needs and contribute to in-hospital mortality. However, most risk prediction models developed to date have focused on AKI in a specific group of patients during hospitalization, and there is limited knowledge on the baseline risk in the general population for preventing CA-AKI-associated hospitalization.ObjectiveTo gain further insight into risk exploration, the aim of this study was to develop, validate, and establish a scoring system to facilitate health professionals in enabling early recognition and intervention of CA-AKI to prevent permanent kidney damage using different machine-learning techniques.MethodsA nested case-control study design was employed using electronic health records derived from a group of Chang Gung Memorial Hospitals in Taiwan from 2010 to 2017 to identify 234,867 adults with at least two measures of serum creatinine at hospital admission. Patients were classified into a derivation cohort (2010-2016) and a temporal validation cohort (2017). Patients with the first episode of CA-AKI at hospital admission were classified into the case group and those without CA-AKI were classified in the control group. A total of 47 potential candidate variables, including age, gender, prior use of nephrotoxic medications, Charlson comorbid conditions, commonly measured laboratory results, and recent use of health services, were tested to develop a CA-AKI hospitalization risk model. Permutation-based selection with both the extreme gradient boost (XGBoost) and least absolute shrinkage and selection operator (LASSO) algorithms was performed to determine the top 10 important features for scoring function development.ResultsThe discriminative ability of the risk model was assessed by the area under the receiver operating characteristic curve (AUC), and the predictive CA-AKI risk model derived by the logistic regression algorithm achieved an AUC of 0.767 (95% CI 0.764-0.770) on derivation and 0.761 on validation for any stage of AKI, with positive and negative predictive values of 19.2% and 96.1%, respectively. The risk model for prediction of CA-AKI stages 2 and 3 had an AUC value of 0.818 for the validation cohort with positive and negative predictive values of 13.3% and 98.4%, respectively. These metrics were evaluated at a cut-off value of 7.993, which was determined as the threshold to discriminate the risk of AKI.ConclusionsA machine learning–generated risk score model can identify patients at risk of developing CA-AKI-related hospitalization through a routine care data-driven approach. The validated multivariate risk assessment tool could help clinicians to stratify patients in primary care, and to provide monitoring and early intervention for preventing AKI while improving the quality of AKI care in the general population.
Highlights
Acute kidney injury (AKI) is defined as an acute increase in serum creatinine (SCr) or reduction in urine volume [1]
Most of the AKI prediction models developed to date focus on a specific group in the hospital setting, such as the risk of hospital-acquired AKI developed following operations [9,10], cardiac procedures [11,12], liver transplantation [13], or intensive care unit admission [14,15,16]; the few studies assessing risk for the general population are prone to external validity bias
A total of 234,867 patients with hospital admission were analyzed in the final Community-acquired acute kidney injury (CA-AKI) cohort; there were 48% admissions from the emergency department and 52% admissions from the outpatient setting between January 1, 2010 and December 31, 2017
Summary
Acute kidney injury (AKI) is defined as an acute increase in serum creatinine (SCr) or reduction in urine volume [1]. Most of the AKI prediction models developed to date focus on a specific group in the hospital setting, such as the risk of hospital-acquired AKI developed following operations [9,10], cardiac procedures [11,12], liver transplantation [13], or intensive care unit admission [14,15,16]; the few studies assessing risk for the general population are prone to external validity bias. Community-acquired acute kidney injury (CA-AKI)-associated hospitalizations impose significant health care needs and contribute to in-hospital mortality. Most risk prediction models developed to date have focused on AKI in a specific group of patients during hospitalization, and there is limited knowledge on the baseline risk in the general population for preventing CA-AKI-associated hospitalization
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