Which risk predictors are more likely to indicate severe AKI in hospitalized patients?,International Journal of Medical Informatics

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Which risk predictors are more likely to indicate severe AKI in hospitalized patients?
International Journal of Medical Informatics ( IF 3.7 ) Pub Date : 2020-09-11 , DOI: 10.1016/j.ijmedinf.2020.104270
Lijuan Wu ₁ , Yong Hu ₁ , Borong Yuan ₁ , Xiangzhou Zhang ₁ , Weiqi Chen ₁ , Kang Liu ₁ , Mei Liu ₂

Affiliation

Objectives

Acute kidney injury (AKI) is a sudden episode of kidney failure or damage and the risk of AKI is determined by the complex interactions of patient factors. In this study, we aimed to find out which risk factors in hospitalized patients are more likely to indicate severe AKI.

Methods

We constructed a retrospective cohort of adult patients from all inpatient units of a tertiary care academic hospital between November 2007 and December 2016. AKI predictors included demographic information, admission and discharge dates, medications, laboratory values, past medical diagnoses and admission diagnosis. We developed a machine learning-based knowledge mining model and a screening framework to analyze which risk predictors are more likely to imply severe AKI in hospitalized populations.

Results

Among the final analysis cohort of 76,957 hospital admissions, AKI occurred in 7,259 (9.43 %) with 6,396 (8.31 %) at stage 1, 678 (0.88 %) at stage 2, and 185 (0.24 %) at stage 3. We compared the non-AKI (without AKI) vs any AKI (stages 1–3), and mild AKI (stage 1) vs severe AKI (stages 2 and 3), where the best cross-validated area under the receiver operator characteristic curve (AUC) were 0.81 (95 % CI, 0.79−0.82) and 0.66 (95 % CI, 0.62−0.71), respectively. Using the developed knowledge mining model and screening framework, we identified 33 risk predictors indicating that severe AKI may occur.

Conclusions

This study screened out 33 risk predictors that are more likely to indicate severe AKI in hospitalized patients, which would help strengthen the early care and prevention of patients.

中文翻译：

哪些风险预测因子更有可能表明住院患者出现严重 AKI？

目标

急性肾损伤 (AKI) 是肾功能衰竭或损伤的突然发作，AKI 的风险由患者因素的复杂相互作用决定。在这项研究中，我们旨在找出住院患者中哪些风险因素更可能表明严重 AKI。

方法

我们构建了 2007 年 11 月至 2016 年 12 月期间来自一家三级医疗学术医院所有住院部的成年患者的回顾性队列。AKI 预测因素包括人口统计信息、入院和出院日期、药物、实验室值、既往医疗诊断和入院诊断。我们开发了一个基于机器学习的知识挖掘模型和一个筛选框架来分析哪些风险预测因子更有可能暗示住院人群中的严重 AKI。

结果

在 76,957 名住院患者的最终分析队列中，AKI 发生率为 7,259 (9.43 %)，其中 6,396 (8.31 %) 在第 1 阶段、678 (0.88 %) 在第 2 阶段和 185 (0.24 %) 在第 3 阶段。我们比较了非 AKI（无 AKI）与任何 AKI（阶段 1-3）、轻度 AKI（阶段 1）与重度 AKI（阶段 2 和 3），其中接受者操作特征曲线 (AUC) 下的最佳交叉验证区域分别为 0.81（95% CI，0.79-0.82）和 0.66（95% CI，0.62-0.71）。使用开发的知识挖掘模型和筛选框架，我们确定了 33 个表明可能发生严重 AKI 的风险预测因素。