False-Positive Rate of AKI Using Consensus Creatinine-Based Criteria
False-Positive Rate of AKI Using Consensus Creatinine-Based Criteria
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DOI：
10.2215/cjn.02430315
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发表时间：
2015-10-01
影响因子：
9.8
通讯作者：
Wilson, F. Perry
中科院分区：
文献类型：
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作者：
Lin, Jennie;Fernandez, Hilda;Wilson, F. Perry
背景和目的利用血清肌酐的微小变化来诊断AKI可以更早地发现，但由于肌酐固有的实验室和生物多样性，可能会增加诊断的假阳性率。设计、设置、参与者和测量我们在2267名符合肾脏疾病改善全球预后肌酐标准的成人AKI患者的前瞻性观察性临床参考队列中检查了血清肌酐的测量特征，并使用这些数据建立了模拟队列来模拟AM的假阳性率。我们模拟了多达七次连续采血，这些患者的真实血清肌酐值不变。将实验室和生物变量产生的误差项添加到每个模拟患者的真实血清肌酐值上，以获得每次抽血的模拟测量血清肌酐。结果在临床队列中，75.0%的患者在住院期间至少一次48小时内接受了四次血肌酐抽吸。在根据化验特征计算实验室变异性的四次模拟肌酐测量和从临床队列和公开可用的数据确定的4.4%的生物变异性之后，AM诊断的总体假阳性率为8.0%(四分位数范围=7.9%-8.1%)，而真血清肌酐和GT的患者；=1.5 mg/dl(占临床队列的21%)的假阳性AKI诊断率为30.5%(四分位数范围=30.1%-30.9%)，而在真实血清肌酐值的患者中为2.0%(四分位数范围=1.9%-2.1%
Background and objectives Use of small changes in serum creatinine to diagnose AKI allows for earlier detection but may increase diagnostic false-positive rates because of inherent laboratory and biologic variabilities of creatinine.Design, setting, participants, & measurements We examined serum creatinine measurement characteristics in a prospective observational clinical reference cohort of 2267 adult patients with AKI by Kidney Disease Improving Global Outcomes creatinine criteria and used these data to create a simulation cohort to model AM false-positive rates. We simulated up to seven successive blood draws on an equal population of hypothetical patients with unchanging true serum creatinine values. Error terms generated from laboratory and biologic variabilities were added to each simulated patient's true serum creatinine value to obtain the simulated measured serum creatinine for each blood draw. We determined the proportion of patients who would be erroneously diagnosed with AM by Kidney Disease Improving Global Outcomes creatinine criteria.Results Within the clinical cohort, 75.0% of patients received four serum creatinine draws within at least one 48-hour period during hospitalization. After four simulated creatinine measurements that accounted for laboratory variability calculated from assay characteristics and 4.4% of biologic variability determined from the clinical cohort and publicly available data, the overall false-positive rate for AM diagnosis was 8.0% (interquartile range =7.9%-8.1%), whereas patients with true serum creatinine >= 1.5 mg/dl (representing 21% of the clinical cohort) had a false-positive AKI diagnosis rate of 30.5% (interquartile range =30.1%-30.9%) versus 2.0% (interquartile range =1.9%-2.1%) in patients with true serum creatinine values