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The ICE-AKI study: Impact analysis of a Clinical prediction rule and Electronic AKI alert in general medical patients

Hodgson, L.E., Roderick, P.J., Venn, R.M., Yao, G.L., Dimitrov, B.D. and Forni, L.G. (2018) The ICE-AKI study: Impact analysis of a Clinical prediction rule and Electronic AKI alert in general medical patients PLoS ONE, 13 (8).

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Acute kidney injury (AKI) is associated with high mortality and measures to improve risk stratification and early identification have been urgently called for. This study investigated whether an electronic clinical prediction rule (CPR) combined with an AKI e-alert could reduce hospital-acquired AKI (HA-AKI) and improve associated outcomes.

Methods and findings

A controlled before-and-after study included 30,295 acute medical admissions to two adult non-specialist hospital sites in the South of England (two ten-month time periods, 2014–16); all included patients stayed at least one night and had at least two serum creatinine tests. In the second period at the intervention site a CPR flagged those at risk of AKI and an alert was generated for those with AKI; both alerts incorporated care bundles. Patients were followed-up until death or hospital discharge. Primary outcome was change in incident HA-AKI. Secondary outcomes in those developing HA-AKI included: in-hospital mortality, AKI progression and escalation of care. On difference-in-differences analysis incidence of HA-AKI reduced (odds ratio [OR] 0.990, 95% CI 0.981–1.000, P = 0.049). In-hospital mortality in HA-AKI cases reduced on difference-in-differences analysis (OR 0.924, 95% CI 0.858–0.996, P = 0.038) and unadjusted analysis (27.46% pre vs 21.67% post, OR 0.731, 95% CI 0.560–0.954, P = 0.021). Mortality in those flagged by the CPR significantly reduced (14% pre vs 11% post intervention, P = 0.008). Outcomes for community-acquired AKI (CA-AKI) cases did not change. A number of process measures significantly improved at the intervention site. Limitations include lack of randomization, and generalizability will require future investigation.


In acute medical admissions a multi-modal intervention, including an electronically integrated CPR alongside an e-alert for those developing HA-AKI improved in-hospital outcomes. CA-AKI outcomes were not affected. The study provides a template for investigations utilising electronically generated prediction modelling. Further studies should assess generalisability and cost effectiveness.

Trial registration NCT03047382.

Item Type: Article
Divisions : Faculty of Health and Medical Sciences > School of Biosciences and Medicine
Authors :
Hodgson, L.E.
Roderick, P.J.
Venn, R.M.
Yao, G.L.
Dimitrov, B.D.
Date : 8 August 2018
DOI : 10.1371/journal.pone.0200584
Copyright Disclaimer : © 2018 Hodgson et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Related URLs :
Additional Information :

Borislav Dimitrov passed away before the submission of the final version of this manuscript. Professor Lui Forni accepts responsibility for the integrity and validity of the data collected and analyzed. Thanks to Mr Tim Short, Mr Mark Dennis and staff at Patientrack for invaluable help with IT integration and data retrieval.

Correction 23 Aug 2018: Hodgson LE, Roderick PJ, Venn RM, Yao GL, Dimitrov BD, et al. (2018) Correction: The ICE-AKI study: Impact analysis of a Clinical prediction rule and Electronic AKI alert in general medical patients. PLOS ONE 13(8): e0203183. | see

Depositing User : Diane Maxfield
Date Deposited : 25 Oct 2019 15:02
Last Modified : 25 Oct 2019 15:15

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