Acute kidney injury and its progression in hospitalized patients-Results from a retrospective multicentre cohort study with a digital decision support system
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Acute kidney injury and its progression in hospitalized patients-Results from a retrospective multicentre cohort study with a digital decision support system. / Kister, Thea; Remmler, Johannes; Schmidt, Maria; Federbusch, Martin; Eckelt, Felix; Isermann, Berend; Richter, Heike; Wehner, Markus; Krause, Uwe; Halbritter, Jan; Cundius, Carina; Voigt, Markus; Kehrer, Alexander; Telle, Jörg Michael; Kaiser, Thorsten.
In: PLOS ONE, Vol. 16, No. 7, 2021, p. e0254608.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Acute kidney injury and its progression in hospitalized patients-Results from a retrospective multicentre cohort study with a digital decision support system
AU - Kister, Thea
AU - Remmler, Johannes
AU - Schmidt, Maria
AU - Federbusch, Martin
AU - Eckelt, Felix
AU - Isermann, Berend
AU - Richter, Heike
AU - Wehner, Markus
AU - Krause, Uwe
AU - Halbritter, Jan
AU - Cundius, Carina
AU - Voigt, Markus
AU - Kehrer, Alexander
AU - Telle, Jörg Michael
AU - Kaiser, Thorsten
PY - 2021
Y1 - 2021
N2 - In this retrospective multicentric cohort study, we evaluate the potential benefits of a clinical decision support system (CDSS) for the automated detection of Acute kidney injury (AKI). A total of 80,389 cases, hospitalized from 2017 to 2019 at a tertiary care hospital (University of Leipzig Medical Center (ULMC)) and two primary care hospitals (Muldentalkliniken (MTL)) in Germany, were enrolled. AKI was defined and staged according to the Kidney disease: improving global outcomes (KDIGO) guidelines. Clinical and laboratory data was automatically collected from electronic patient records using the frameworks of the CDSS. In our cohort, we found an overall AKI incidence proportion of 12.1%. We identified 6,393/1,703/1,604 cases as AKI stage 1/2/3 (8.0%/2.1%/2.0%, respectively). Administrative coding with N17 (ICD-10-GM) was missing in 55.8% of all AKI cases with the potential for additional diagnosis related groups (DRG) reimbursement of 1,204,200 € in our study. AKI was associated with higher hospital mortality, increased length of hospitalisation and more frequent need of renal replacement therapy. A total of 19.1% of AKI cases (n = 1,848) showed progression to higher AKI stages (progressive AKI) during hospitalization. These cases presented with considerably longer hospitalization, higher rates of renal replacement therapy and increased mortality (p<0.001, respectively). Furthermore, progressive AKI was significantly associated with sepsis, shock, liver cirrhosis, myocardial infarction, and cardiac insufficiency. AKI, and especially its progression during hospitalization, is strongly associated with adverse outcomes. Our automated CDSS enables timely detection and bears potential to improve AKI outcomes, notably in cases of progressive AKI.
AB - In this retrospective multicentric cohort study, we evaluate the potential benefits of a clinical decision support system (CDSS) for the automated detection of Acute kidney injury (AKI). A total of 80,389 cases, hospitalized from 2017 to 2019 at a tertiary care hospital (University of Leipzig Medical Center (ULMC)) and two primary care hospitals (Muldentalkliniken (MTL)) in Germany, were enrolled. AKI was defined and staged according to the Kidney disease: improving global outcomes (KDIGO) guidelines. Clinical and laboratory data was automatically collected from electronic patient records using the frameworks of the CDSS. In our cohort, we found an overall AKI incidence proportion of 12.1%. We identified 6,393/1,703/1,604 cases as AKI stage 1/2/3 (8.0%/2.1%/2.0%, respectively). Administrative coding with N17 (ICD-10-GM) was missing in 55.8% of all AKI cases with the potential for additional diagnosis related groups (DRG) reimbursement of 1,204,200 € in our study. AKI was associated with higher hospital mortality, increased length of hospitalisation and more frequent need of renal replacement therapy. A total of 19.1% of AKI cases (n = 1,848) showed progression to higher AKI stages (progressive AKI) during hospitalization. These cases presented with considerably longer hospitalization, higher rates of renal replacement therapy and increased mortality (p<0.001, respectively). Furthermore, progressive AKI was significantly associated with sepsis, shock, liver cirrhosis, myocardial infarction, and cardiac insufficiency. AKI, and especially its progression during hospitalization, is strongly associated with adverse outcomes. Our automated CDSS enables timely detection and bears potential to improve AKI outcomes, notably in cases of progressive AKI.
KW - Acute Kidney Injury/epidemiology
KW - Aged
KW - Disease Progression
KW - Female
KW - Hospitalization/statistics & numerical data
KW - Humans
KW - Incidence
KW - Kaplan-Meier Estimate
KW - Male
KW - Middle Aged
KW - Retrospective Studies
U2 - 10.1371/journal.pone.0254608
DO - 10.1371/journal.pone.0254608
M3 - SCORING: Journal article
C2 - 34252151
VL - 16
SP - e0254608
JO - PLOS ONE
JF - PLOS ONE
SN - 1932-6203
IS - 7
ER -