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 Forni; Martin 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

doi:10.1093/qjmed/hcy277

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

Population Health and Genomics

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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 language	English
Pages (from-to)	197-205
Number of pages	9
Journal	QJM
Volume	112
Issue number	3
Early online date	28 Nov 2018
DOIs	https://doi.org/10.1093/qjmed/hcy277
Publication status	Published - 1 Mar 2019

Keywords

Acute Kidney Injury
AKI
clinical prediction score
risk score
acute medicine

ASJC Scopus subject areas

General Medicine

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10.1093/qjmed/hcy277

Author Accepted ManuscriptAccepted author manuscript, 342 KB

Cite this

Blackburn, A., Gunda, S., Lopez, B., Edwards, J., Spittle, N., Preston, R., Baines, R., Little, J., Falayajo, A., Mahmoud, H., Selby, N. M., Shaw, S., Trowbridge, S., Coutinho, A., Samarasinghe, Y., Farmer, C., Beeson, C., John, I., Gisby, S., ... Than, N. (2019). Risk prediction for acute kidney injury in acute medical admissions in the UK. QJM, 112(3), 197-205. https://doi.org/10.1093/qjmed/hcy277

@article{b8e4851633c2441185aed2348ba27140,

title = "Risk prediction for acute kidney injury in acute medical admissions in the UK",

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.",

keywords = "Acute Kidney Injury, AKI, clinical prediction score, risk score, acute medicine",

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

year = "2019",

month = mar,

day = "1",

doi = "10.1093/qjmed/hcy277",

language = "English",

volume = "112",

pages = "197--205",

journal = "QJM",

issn = "1460-2725",

publisher = "Oxford University Press",

number = "3",

}

Blackburn, A, Gunda, S, Lopez, B, Edwards, J, Spittle, N, Preston, R, Baines, R, Little, J, Falayajo, A, Mahmoud, H, Selby, NM, Shaw, S, Trowbridge, S, Coutinho, A, Samarasinghe, Y, Farmer, C, Beeson, C, John, I, Gisby, S, Forni, L, Dachsel, M, Fallouh, B, Ward, E, Sood, B, Ostermann, M, Mohanty, M, Robert, S, MacLaughlin, H, Banerjee, A, Wright, K, Tomlinson, L, De Wolff, J, Laing, C, Prowle, J, Defreitas, S, Balasubramaniam, G, McGuiness, D, Murray, J, Kanagasundaram, S, Harron, C, Magee, B, Harty, J, Maxwell, P, Morgan, N, Leaonard, N, McCarroll, F, Kuan, Y, Chakraborty, T, Ahmed, A, Ponnusamy, A, Brown, B, Ahmed, S, Henney, B, Hammersley, S, Obale, B, Nipah, R, Al-Sayed, T, Varia, R, Skinner, C, Young, I, Clark, L, Bassiouni, I, Finlay, S, Moonie, A, Douglas, A, Bell, S, Duthie, F, Thetford, D, White, B, McQuarrie, E, McCallum, L, Campbell, I, Millar, J, McCormick, JL, Allen, R, Jamdar, R, Murray, E, Hand, M, Harmouche, A, Fattah, H, Farquhar, F, Condy-Young, H, Morrison, J, Power, B, Udayaraj, U, Murray, P, Mulgrew, C, Boddana, P, Prescott, C, Uniake, M, Bonfield, B, Edwards, H, Armstrong, K, Whitehead, D, Miller, A, Waters, H, Carr, S, Dickinson, S, Subbe, C, Phillips, A, Thomas, D, Lewis, A, Chess, J, Price, D, Mizen, P, Ramasamy, V, Thomas, M, Hewins, P, Carmichael, P, Chand, R, Ramaswamy, D, Thompson, C, Morgan, J, Lobaz, S, Oh, W, Stoves, J, Ali, A, Ali, M, Awais, M, Naudeer, S, Lewington, A, McDonald, S, Naeem, H & Than, N 2019, 'Risk prediction for acute kidney injury in acute medical admissions in the UK', QJM, vol. 112, no. 3, pp. 197-205. https://doi.org/10.1093/qjmed/hcy277

TY - JOUR

T1 - Risk prediction for acute kidney injury in acute medical admissions in the UK

AU - Blackburn, Anna

AU - Gunda, Smita

AU - Lopez, Berenice

AU - Edwards, James

AU - Spittle, Nick

AU - Preston, Rob

AU - Baines, Richard

AU - Little, Jane

AU - Falayajo, Akin

AU - Mahmoud, Huda

AU - Selby, Nicholas M.

AU - Shaw, Sue

AU - Trowbridge, Stephen

AU - Coutinho, Andrew

AU - Samarasinghe, Yohan

AU - Farmer, Chris

AU - Beeson, Claire

AU - John, Ian

AU - Gisby, Sharon

AU - Forni, Lui

AU - Dachsel, Martin

AU - Fallouh, Bassam

AU - Ward, Emily

AU - Sood, Bhrigu

AU - Ostermann, Marlies

AU - Mohanty, Manab

AU - Robert, Stephanie

AU - MacLaughlin, Helen

AU - Banerjee, Anita

AU - Wright, Kelly

AU - Tomlinson, Laurie

AU - De Wolff, Jacob

AU - Laing, Chris

AU - Prowle, John

AU - Defreitas, Sarah

AU - Balasubramaniam, Gowrie

AU - McGuiness, Daniel

AU - Murray, Jon

AU - Kanagasundaram, Suren

AU - Harron, Camille

AU - Magee, Brian

AU - Harty, John

AU - Maxwell, Peter

AU - Morgan, Neal

AU - Leaonard, Niall

AU - McCarroll, Frank

AU - Kuan, Ying

AU - Chakraborty, Tapas

AU - Ahmed, Aimun

AU - Ponnusamy, Arvind

AU - Brown, Becky

AU - Ahmed, Shahed

AU - Henney, Bob

AU - Hammersley, Shirley

AU - Obale, Begho

AU - Nipah, Rob

AU - Al-Sayed, Tam

AU - Varia, Ragit

AU - Skinner, Christopher

AU - Young, Innes

AU - Clark, Laura

AU - Bassiouni, Ibrahim

AU - Finlay, Sian

AU - Moonie, Alasdair

AU - Douglas, Alistair

AU - Bell, Samira

AU - Duthie, Fiona

AU - Thetford, David

AU - White, Beth

AU - McQuarrie, Emily

AU - McCallum, Lindsay

AU - Campbell, Iona

AU - Millar, James

AU - McCormick, Jenna L.

AU - Allen, Ruridh

AU - Jamdar, Ravi

AU - Murray, Eleanor

AU - Hand, Malcolm

AU - Harmouche, Ali

AU - Fattah, Hasan

AU - Farquhar, Fiona

AU - Condy-Young, Helen

AU - Morrison, Jennifer

AU - Power, Bert

AU - Udayaraj, Uday

AU - Murray, Paul

AU - Mulgrew, Chris

AU - Boddana, Preetham

AU - Prescott, Craig

AU - Uniake, Mark

AU - Bonfield, Becky

AU - Edwards, Helena

AU - Armstrong, Kirsty

AU - Whitehead, Duncan

AU - Miller, Alice

AU - Waters, Helen

AU - Carr, Steve

AU - Dickinson, Steve

AU - Subbe, Chris

AU - Phillips, Aled

AU - Thomas, David

AU - Lewis, Aled

AU - Chess, James

AU - Price, David

AU - Mizen, Paul

AU - Ramasamy, Vijaya

AU - Thomas, Mark

AU - Hewins, Pete

AU - Carmichael, Paul

AU - Chand, Rob

AU - Ramaswamy, Diwaker

AU - Thompson, Chris

AU - Morgan, James

AU - Lobaz, Steven

AU - Oh, Weng

AU - Stoves, John

AU - Ali, Asifa

AU - Ali, Mansoor

AU - Awais, Muhammed

AU - Naudeer, Sarah

AU - Lewington, Andy

AU - McDonald, Suzanne

AU - Naeem, Haroon

AU - Than, Nilar

PY - 2019/3/1

Y1 - 2019/3/1

N2 - 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.

AB - 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.

KW - Acute Kidney Injury

KW - AKI

KW - clinical prediction score

KW - risk score

KW - acute medicine

UR - http://www.scopus.com/inward/record.url?scp=85062297156&partnerID=8YFLogxK

U2 - 10.1093/qjmed/hcy277

DO - 10.1093/qjmed/hcy277

M3 - Article

C2 - 30496574

AN - SCOPUS:85062297156

SN - 1460-2725

VL - 112

SP - 197

EP - 205

JO - QJM

JF - QJM

IS - 3

ER -

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

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Bell, Samira

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

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ASJC Scopus subject areas

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Bell, Samira

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