Utilization of small changes in serum creatinine with clinical risk factors to assess the risk of AKI in critically ill adults
Clinical Journal of the American Society of Nephrology, ISSN: 1555-905X, Vol: 9, Issue: 4, Page: 663-672
2014
- 42Citations
- 70Captures
- 1Mentions
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Example: if you select the 1-year option for an article published in 2019 and a metric category shows 90%, that means that the article or review is performing better than 90% of the other articles/reviews published in that journal in 2019. If you select the 3-year option for the same article published in 2019 and the metric category shows 90%, that means that the article or review is performing better than 90% of the other articles/reviews published in that journal in 2019, 2018 and 2017.
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Metrics Details
- Citations42
- Citation Indexes42
- 42
- CrossRef35
- Captures70
- Readers70
- 70
- Mentions1
- References1
- Wikipedia1
Article Description
Background and objectives Disease biomarkers require appropriate clinical context to be used effectively. Combining clinical risk factors, in addition to small changes in serum creatinine, has been proposed to improve the assessment of AKI. This notion was developed in order to identify the risk of AKI early in a patient’s clinical course. We set out to assess the performance of this combination approach. Design, setting, participants, & measurements A secondary analysis of data from a prospective multicenter intensive care unit cohort study (September 2009 to April 2010) was performed. Patients at high risk using this combination approach were defined as an early increase in serum creatinine of 0.1–0.4 mg/dl, depending on number of clinical factors predisposing to AKI. AKI was defined and staged using the Acute Kidney Injury Network criteria. The primary outcome was evolution to severe AKI (Acute Kidney Injury Network stages 2 and 3) within 7 days in the intensive care unit. Results Of 506 patients, 214 (42.2%) patients had early creatinine elevation and were deemed at high risk for AKI. This group was more likely to subsequently develop the primary endpoint (16.4% versus 1.0% [not at high risk], P<0.001). The sensitivity of this grouping for severe AKI was 92%, the specificity was 62%, the positive predictive value was 16%, and the negative predictive value was 99%. After adjustment for Sequential Organ Failure Assessment score, serum creatinine, and hazard tier for AKI, early creatinine elevation remained an independent predictor for severe AKI (adjusted relative risk, 12.86; 95% confidence interval, 3.52 to 46.97). Addition ofearlycreatinine elevationtothebest clinicalmodelimproved prediction of theprimary outcome(area under the receiver operating characteristic curve increased from 0.75 to 0.83, P<0.001). Conclusion Critically ill patients at high AKI risk, based on the combination of clinical factors and early creatinine elevation, are significantly more likely to develop severe AKI. As initially hypothesized, the high-risk combination group methodology can be used to identify patients at low risk for severe AKI in whom AKI biomarker testing may be expected to have low yield. The high risk combination group methodology could potentially allow clinicians to optimize biomarker use.
Bibliographic Details
http://www.scopus.com/inward/record.url?partnerID=HzOxMe3b&scp=84922274385&origin=inward; http://dx.doi.org/10.2215/cjn.05190513; http://www.ncbi.nlm.nih.gov/pubmed/24677553; http://cjasn.asnjournals.org/cgi/doi/10.2215/CJN.05190513; https://syndication.highwire.org/content/doi/10.2215/CJN.05190513; https://journals.lww.com/01277230-201404000-00008; http://dx.doi.org/10.2215/CJN.05190513; https://dx.doi.org/10.2215/CJN.05190513; https://journals.lww.com/cjasn/fulltext/2014/04000/utilization_of_small_changes_in_serum_creatinine.8.aspx; http://cjasn.asnjournals.org/lookup/doi/10.2215/CJN.05190513; https://cjasn.asnjournals.org/content/9/4/663; https://cjasn.asnjournals.org/content/9/4/663.abstract; https://cjasn.asnjournals.org/content/clinjasn/9/4/663.full.pdf; https://cjasn.asnjournals.org/content/9/4/663.full.pdf; http://cjasn.asnjournals.org/content/9/4/663
American Society of Nephrology (ASN)
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