OBJECTIVE To develop and validate an acute kidney injury (AKI) risk prediction model for hospitalized non-critically ill patients. PATIENTS AND METHODS We retrospectively identified all Olmsted County, Minnesota, residents admitted to non-intensive care unit (ICU) wards at Mayo Clinic Hospital, Rochester, Minnesota, in 2013 and 2014. The cohort was divided into development and validation sets by year. The primary outcome was hospital-acquired AKI defined by Kidney Disease: Improving Global Outcomes criteria. Cox regression was used to analyze mortality data. Comorbid risk factors for AKI were identified, and a multivariable model was developed and validated. RESULTS The development and validation cohorts included 3816 and 3232 adults, respectively. Approximately 10% of patients in both cohorts had AKI, and patients with AKI had an increased risk of death (hazard ratio, 3.62; 95% CI, 2.97-4.43; P<.001). Significant univariate determinants of AKI were preexisting kidney disease, diabetes mellitus, hypertension, heart failure, vascular disease, coagulopathy, pulmonary disease, coronary artery disease, cancer, obesity, liver disease, and weight loss (all P<.05). The final multivariable model included increased baseline serum creatinine value, admission to a medical service, pulmonary disease, diabetes mellitus, kidney disease, cancer, hypertension, and vascular disease. The area under the receiver operating characteristic curves for the development and validation cohorts were 0.71 (95% CI, 0.69-0.75) and 0.75 (95% CI, 0.72-0.78), respectively. CONCLUSION Hospital-acquired AKI is common in non-ICU inpatients and is associated with worse outcomes. Patient data at admission can be used to identify increased risk; such patients may benefit from more intensive monitoring and earlier intervention and testing with emerging biomarkers.

中文翻译：

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住院非重症患者急性肾脏损伤的危险因素：一项基于人群的研究。

目的建立并验证住院非重症患者急性肾损伤（AKI）风险预测模型。患者与方法我们回顾性地确定了2013年和2014年在明尼苏达州Olmsted县所有进入非加护病房（ICU）病房的居民，该病房位于明尼苏达州罗切斯特市梅奥诊所。主要结局是根据肾脏疾病：改善全球结局标准定义的医院获得的AKI。使用Cox回归分析死亡率数据。确定了AKI的合并症危险因素，并开发和验证了多变量模型。结果开发和验证队列分别包括3816和3232名成年人。两个队列中约有10％的患者患有AKI，而AKI患者的死亡风险增加（危险比3.62； 95％CI为2.97-4.43； P <.001）。AKI的重要单因素决定因素是预先存在的肾脏疾病，糖尿病，高血压，心力衰竭，血管疾病，凝血病，肺病，冠状动脉疾病，癌症，肥胖症，肝病和体重减轻（所有P <.05）。最终的多变量模型包括基线血肌酐水平升高，就医，肺部疾病，糖尿病，肾脏疾病，癌症，高血压和血管疾病。发育和验证队列的接收器工作特征曲线下的面积分别为0.71（95％CI，0.69-0.75）和0.75（95％CI，0.72-0.78）。结论医院获得性AKI在非ICU住院患者中很常见，并且与预后差有关。入院时的患者数据可用于识别风险增加；此类患者可能会受益于更深入的监测以及早期对新兴生物标志物的干预和测试。