Risk prediction for acute kidney injury in acute medical admissions in the UK

Anna Blackburn, Smita Gunda, Berenice Lopez, James Edwards, Nick Spittle, Rob Preston, Richard Baines, Jane Little, Akin Falayajo, Huda Mahmoud, Nicholas M. Selby, Sue Shaw, Stephen Trowbridge, Andrew Coutinho, Yohan Samarasinghe, Chris Farmer, Claire Beeson, Ian John, Sharon Gisby, Lui ForniMartin Dachsel, Bassam Fallouh, Emily Ward, Bhrigu Sood, Marlies Ostermann, Manab Mohanty, Stephanie Robert, Helen MacLaughlin, Anita Banerjee, Kelly Wright, Laurie Tomlinson, Jacob De Wolff, Chris Laing, John Prowle, Sarah Defreitas, Gowrie Balasubramaniam, Daniel McGuiness, Jon Murray, Suren Kanagasundaram, Camille Harron, Brian Magee, John Harty, Peter Maxwell, Neal Morgan, Niall Leaonard, Frank McCarroll, Ying Kuan, Tapas Chakraborty, Aimun Ahmed, Arvind Ponnusamy, Becky Brown, Shahed Ahmed, Bob Henney, Shirley Hammersley, Begho Obale, Rob Nipah, Tam Al-Sayed, Ragit Varia, Christopher Skinner, Innes Young, Laura Clark, Ibrahim Bassiouni, Sian Finlay, Alasdair Moonie, Alistair Douglas, Samira Bell, Fiona Duthie, David Thetford, Beth White, Emily McQuarrie, Lindsay McCallum, Iona Campbell, James Millar, Jenna L. McCormick, Ruridh Allen, Ravi Jamdar, Eleanor Murray, Malcolm Hand, Ali Harmouche, Hasan Fattah, Fiona Farquhar, Helen Condy-Young, Jennifer Morrison, Bert Power, Uday Udayaraj, Paul Murray, Chris Mulgrew, Preetham Boddana, Craig Prescott, Mark Uniake, Becky Bonfield, Helena Edwards, Kirsty Armstrong, Duncan Whitehead, Alice Miller, Helen Waters, Steve Carr, Steve Dickinson, Chris Subbe, Aled Phillips, David Thomas, Aled Lewis, James Chess, David Price, Paul Mizen, Vijaya Ramasamy, Mark Thomas, Pete Hewins, Paul Carmichael, Rob Chand, Diwaker Ramaswamy, Chris Thompson, James Morgan, Steven Lobaz, Weng Oh, John Stoves, Asifa Ali, Mansoor Ali, Muhammed Awais, Sarah Naudeer, Andy Lewington, Suzanne McDonald, Haroon Naeem, Nilar Than

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Abstract

Background Acute Kidney Injury (AKI) is associated with adverse outcomes; therefore identifying patients who are at risk of developing AKI in hospital may lead to targeted prevention. Aim We undertook a UK-wide study in acute medical units (AMUs) to define those who develop hospital-Acquired AKI (hAKI); to determine risk factors associated with hAKI and to assess the feasibility of developing a risk prediction score. Design Prospective multi-centre cohort study across 72 AMUs in the UK. Methods Data collected from all patients who presented over a 24-h period. Chronic dialysis, community-Acquired AKI (cAKI) and those with fewer than two creatinine measurements were excluded. Primary outcome was the development of h-AKI. Results Two thousand four hundred and fourty-six individuals were admitted to the seventy-Two participating centres. Three hundred and eighty-four patients (16%) sustained AKI of whom two hundred and eighty-seven (75%) were cAKI and ninety-seven (25%) were hAKI. After exclusions, chronic kidney disease [Odds Ratio (OR) 3.08, 95% Confidence Interval (CI) 1.96-4.83], diuretic prescription (OR 2.33, 95% CI 1.5-3.65), a lower haemoglobin concentration and elevated serum bilirubin were independently associated with development of hAKI. Multi-variable model discrimination was only moderate (c-statistic 0.75). Conclusions AKI in AMUs is common and associated with worse outcomes, with the majority of cases community acquired. Only a small proportion of patients develop hAKI. Prognostic risk factor modelling demonstrated only moderate discrimination implying that widespread adoption of such an AKI clinical risk score across all AMU admissions is not currently justified. More targeted risk assessment or automated methods of calculating individual risk may be more appropriate alternatives.

Original languageEnglish
Pages (from-to)197-205
Number of pages9
JournalQJM
Volume112
Issue number3
Early online date28 Nov 2018
DOIs
Publication statusPublished - 1 Mar 2019

Keywords

  • Acute Kidney Injury
  • AKI
  • clinical prediction score
  • risk score
  • acute medicine

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