Commonly used surrogates for baseline renal function affect the classification and prognosis of acute kidney injury.
Commonly used surrogates for baseline renal function affect the classification and prognosis of acute kidney injury.
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DOI：
10.1038/ki.2009.479
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发表时间：
2010-03
影响因子：
19.6
通讯作者：
Peterson, Josh F.
中科院分区：
文献类型：
--
作者：
Siew, Edward D.;Matheny, Michael E.;Ikizler, T. Alp;Lewis, Julie B.;Miller, Randolph A.;Waitman, Lemuel R.;Go, Alan S.;Parikh, Chirag R.;Peterson, Josh F.
急性肾损伤（AKI）的研究通常缺乏入院前肾功能的数据，通常用住院患者或估算的血清肌酐（SCr）作为“基线”肾功能的估计值。我们检查了应用方法估计 AKI 分类和死亡率的“基线”时引入的误差。在 10/07 至 10/08 期间入住范德比尔特大学医院的 4863 名已知门诊基线成人队列中，研究了以下替代指标：(1) 根据急性透析质量倡议 (ADQI) 的建议，eGFR 为 75 ml/min/1.73m2，(2) 最低住院患者 SCr，以及 (3) 首次入院 SCr。我们使用每个替代者计算了 AKI 发病率和死亡率，并与入院前 7-365 天之间最近的门诊 SCr 相比，评估了他们正确分类 AKI 发病率和死亡率的能力。使用估算和最小基线 SCr 值夸大了 AKI 发生率（38.3% 和 35.9% vs. 25.5%；p<0.001），分别反映了 77% 和 80% 的低特异性。相反，使用入院 SCr 基线低估了 AKI 发生率（13.7% vs. 25.5%，p<0.001），表明敏感性较低，为 39%。使用任何替代指标都会导致患者死亡频繁被错误分类为 AKI 后，以及院内死亡率和 60 天死亡率之间的差异。总之，常用的基线 SCr 替代指标会导致住院环境中 AKI 发病率和预后的双向错误分类。
Studies of acute kidney injury (AKI) commonly lack data on pre-admission renal function, often substituting an inpatient or imputed serum creatinine (SCr) as an estimate for “baseline” renal function. We examined the error introduced when applying methods to estimate “baseline” on AKI classification and mortality. Within a cohort of 4863 adults with a known outpatient baseline admitted to Vanderbilt University Hospital between 10/07 and 10/08, the following surrogates were studied: (1) an eGFR of 75 ml/min/1.73m2 as suggested by the Acute Dialysis Quality Initiative (ADQI), (2) a minimum inpatient SCr, and (3) the first admission SCr. We calculated AKI incidence and mortality rates using each surrogate, and assessed their ability to correctly classify AKI incidence and mortality compared to the most recent outpatient SCr between 7-365 days before admission. Using both imputed and minimum baseline SCr values inflated AKI incidence (38.3% and 35.9% vs. 25.5%; p<0.001), reflecting low specificities of 77% and 80%, respectively. In contrast, using an admission SCr baseline underestimated AKI incidence (13.7% vs. 25.5%, p<0.001), demonstrating a low sensitivity of 39%. Using any surrogate led to frequent misclassification of patient deaths as following AKI and differences for both in-hospital and 60-day mortality rates. In summary, commonly used surrogates for baseline SCr result in bi-directional misclassification of AKI incidence and prognosis in a hospitalized setting.
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急性肾脏损伤的步枪标准与重症患者的医院死亡率有关：一项队列分析。
影响因子：
15.1
作者：
Hoste, Eric A. J.;Clermont, Gilles;Kersten, Alexander;Venkataraman, Ramesh;Angus, Derek C.;De Bacquer, Dirk;Kellum, John A.
通讯作者：
Kellum, John A.
影响因子：
13.2
作者：
Coca, Steven G.;Peixoto, Aldo J.;Parikh, Chirag R.
通讯作者：
Parikh, Chirag R.
影响因子：
13.6
作者：
Ishani, Areef;Xue, Jay L.;Collins, Allan J.
通讯作者：
Collins, Allan J.
影响因子：
8.8
作者：
Uchino, Shigehiko;Bellomo, Rinaldo;Ronco, Claudio
通讯作者：
Ronco, Claudio
DOI：
10.3736/jcim20080520
发表时间：
2008-05-01
期刊：
Zhong xi yi jie he xue bao = Journal of Chinese integrative medicine
影响因子：
--
作者：
Ichimura, Takaharu;Mou, Shan
通讯作者：
Mou, Shan