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Systematic review of prognostic prediction models for acute kidney injury (AKI) in general hospital populations

Hodgson, L.E., Sarnowski, A., Roderick, P.J., Dimitrov, B.D., Venn, R.M. and Forni, Lui G. (2017) Systematic review of prognostic prediction models for acute kidney injury (AKI) in general hospital populations BMJ Open, 7 (9).

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Objective: Critically appraise prediction models for hospital-acquired acute kidney injury (HA-AKI) in general populations. Design Systematic review. Data sources Medline, Embase and Web of Science until November 2016. Eligibility: Studies describing development of a multivariable model for predicting HA-AKI in nonspecialised adult hospital populations. Published guidance followed for data extraction reporting and appraisal. Results: 14 046 references were screened. Of 53 HA-AKI prediction models, 11 met inclusion criteria (general medicine and/or surgery populations, 474 478 patient episodes) and five externally validated. The most common predictors were age (n=9 models), diabetes (5), admission serum creatinine (SCr) (5), chronic kidney disease (CKD) (4), drugs (diuretics (4) and/or ACE inhibitors/angiotensin-receptor blockers (3)), bicarbonate and heart failure (4 models each). Heterogeneity was identified for outcome definition. Deficiencies in reporting included handling of predictors, missing data and sample size. Admission SCr was frequently taken to represent baseline renal function. Most models were considered at high risk of bias. Area under the receiver operating characteristic curves to predict HA-AKI ranged 0.71–0.80 in derivation (reported in 8/11 studies), 0.66–0.80 for internal validation studies (n=7) and 0.65–0.71 in five external validations. For calibration, the Hosmer- Lemeshow test or a calibration plot was provided in 4/11 derivations, 3/11 internal and 3/5 external validations. A minority of the models allow easy bedside calculation and potential electronic automation. No impact analysis studies were found. Conclusions: AKI prediction models may help address shortcomings in risk assessment; however, in general hospital populations, few have external validation. Similar predictors reflect an elderly demographic with chronic comorbidities. Reporting deficiencies mirrors prediction research more broadly, with handling of SCr (baseline function and use as a predictor) a concern. Future research should focus on validation, exploration of electronic linkage and impact analysis. The latter could combine a prediction model with AKI alerting to address prevention and early recognition of evolving AKI.

Item Type: Article
Divisions : Faculty of Health and Medical Sciences > School of Biosciences and Medicine
Authors :
Hodgson, L.E.
Sarnowski, A.
Roderick, P.J.
Dimitrov, B.D.
Venn, R.M.
Forni, Lui
Date : 27 September 2017
DOI : 10.1136/bmjopen-2017-016591
Copyright Disclaimer : © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted. This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Depositing User : Diane Maxfield
Date Deposited : 24 Oct 2019 15:23
Last Modified : 24 Oct 2019 15:23

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