Clinical Pharmacology Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
BMC Nephrol. 2013 Mar 13;14:58. doi: 10.1186/1471-2369-14-58.
Acute kidney injury (AKI) is an independent risk factor for mortality and is responsible for a significant burden of healthcare expenditure, so accurate measurement of its incidence is important. Administrative coding data has been used for assessing AKI incidence, and shows an increasing proportion of hospital bed days attributable to AKI. However, the accuracy of coding for AKI and changes in coding over time have not been studied in England.
We studied a random sample of admissions from 2005 and 2010 where ICD-10 code N17 (acute renal failure) was recorded in the administrative coding data at one acute NHS Foundation Trust in England. Using the medical notes and computerised records we examined the demographic and clinical details of these admissions.
Against a 6.3% (95% CI 4.8-7.9%) increase in all non-elective admissions, we found a 64% increase in acute renal failure admissions (95% CI 41%-92%, p < 0.001) in 2010 compared to 2005. Median age was 78 years (IQR 72-87), 11-25% had a relevant pre-admission co-morbidity and 64% (55-73%) were taking drugs known to be associated with AKI. Over both years, 95% (91-99%) of cases examined met the Kidney Disease: Improving Global Outcomes criteria for AKI.
Patients with hospital admissions where AKI has been coded are elderly with multiple co-morbidities. Our results demonstrate a high positive predictive value of coding data for a clinical diagnosis of AKI, with no suggestion of marked changes in coding of AKI between 2005 and 2010.
急性肾损伤 (AKI) 是死亡的独立危险因素，也是医疗支出的重要负担，因此准确测量其发病率很重要。行政编码数据已用于评估 AKI 的发病率，并显示与 AKI 相关的住院天数比例不断增加。然而，编码 AKI 的准确性以及随时间变化的编码变化在英国尚未得到研究。
我们研究了来自英格兰一家 NHS 基金会信托的 2005 年和 2010 年的随机抽样入院患者，其中 ICD-10 编码 N17（急性肾功能衰竭）在行政编码数据中记录。我们使用病历和计算机记录检查了这些入院患者的人口统计学和临床细节。
在所有非选择性入院人数增加 6.3%（95%CI 4.8-7.9%）的情况下，我们发现 2010 年与 2005 年相比，急性肾功能衰竭入院人数增加了 64%（95%CI 41%-92%，p<0.001）。中位年龄为 78 岁（IQR 72-87），11-25%有相关的入院前合并症，64%（55-73%）正在服用已知与 AKI 相关的药物。在这两年中，95%（91-99%）检查的病例符合改善全球肾脏病预后组织的 AKI 标准。
患有编码 AKI 的住院患者年龄较大，合并多种疾病。我们的结果表明，编码数据对 AKI 的临床诊断具有很高的阳性预测值，并且在 2005 年至 2010 年间编码 AKI 没有明显变化的迹象。
