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电子急性肾损伤 (AKI) 警报与自动肾脏病专家咨询对 AKI 的检测和严重程度的影响：一项质量改进研究。

Impact of Electronic Acute Kidney Injury (AKI) Alerts With Automated Nephrologist Consultation on Detection and Severity of AKI: A Quality Improvement Study.

机构信息

Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Korea.

Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Gyeonggi-do, Korea.

出版信息

Am J Kidney Dis. 2018 Jan;71(1):9-19. doi: 10.1053/j.ajkd.2017.06.008. Epub 2017 Jul 25.

DOI:10.1053/j.ajkd.2017.06.008

PMID:28754457

Abstract

BACKGROUND

Several electronic alert systems for acute kidney injury (AKI) have been introduced. However, their clinical benefits require further investigation.

STUDY DESIGN

Before-and-after quality improvement study.

SETTING & PARTICIPANTS: A tertiary teaching hospital in Korea, which adopted an AKI alert system on June 1, 2014. Before and after launch of the alert system, 1,884 and 1,309 patients with AKI were included in the usual-care and alert groups, respectively.

QUALITY IMPROVEMENT PLAN

Implementation of an AKI alert system through which clinicians could generate automated consultations to the nephrology division for all hospitalized patients.

OUTCOMES

Primary outcomes included overlooked AKI events, defined as not measuring the follow-up creatinine value, and the consultation pattern of clinicians. Secondary outcomes were severe AKI events; AKI recovery, defined based on the creatinine-based criterion; and patient mortality.

MEASUREMENTS

ORs for events of overlooked AKI, early consultation, and severe AKI were calculated with logistic regression. AKI recovery rate and patient mortality were assessed using Cox regression.

RESULTS

After introduction of the alert system, the odds of overlooked AKI events were significantly lower (adjusted OR, 0.40; 95% CI, 0.30-0.52), and the odds of an early consultation with a nephrologist were greater (adjusted OR, 6.13; 95% CI, 4.80-7.82). The odds of a severe AKI event was reduced after implementation of the alerts (adjusted OR, 0.75; 95% CI, 0.64-0.89). Furthermore, the likelihood of AKI recovery was improved in the alert group (adjusted HR, 1.70; 95% CI, 1.53-1.88). Mortality was not affected by the AKI alert system (adjusted HR, 1.07; 95% CI, 0.68-1.68).

LIMITATIONS

Possible unreported differences between the alert and usual-care groups.

CONCLUSIONS

Implementation of the AKI alert system was associated with beneficial effects in terms of an improved rate of recovery from AKI. Therefore, widespread adoption of such systems could be considered in general hospitals.

摘要

背景

已经引入了几种用于急性肾损伤（AKI）的电子警报系统。然而，它们的临床获益仍需要进一步研究。

研究设计

前后质量改进研究。

地点和参与者

韩国的一家三级教学医院，于 2014 年 6 月 1 日采用 AKI 警报系统。在推出警报系统之前和之后，分别有 1884 名和 1309 名 AKI 患者被纳入常规护理组和警报组。

质量改进计划

通过该计划，临床医生可以为所有住院患者自动向肾脏病科发出咨询请求，从而实施 AKI 警报系统。

结局

主要结局包括漏诊 AKI 事件，定义为未测量后续肌酐值，以及临床医生的咨询模式。次要结局为严重 AKI 事件；基于肌酐标准的 AKI 恢复定义；以及患者死亡率。

测量

使用逻辑回归计算漏诊 AKI 事件、早期咨询和严重 AKI 事件的比值比（OR）。使用 Cox 回归评估 AKI 恢复率和患者死亡率。

结果

在引入警报系统后，漏诊 AKI 事件的可能性显著降低（调整后的 OR，0.40；95%CI，0.30-0.52），并且与肾脏病专家进行早期咨询的可能性更大（调整后的 OR，6.13；95%CI，4.80-7.82）。实施警报后，严重 AKI 事件的可能性降低（调整后的 OR，0.75；95%CI，0.64-0.89）。此外，在警报组中 AKI 恢复的可能性提高（调整后的 HR，1.70；95%CI，1.53-1.88）。AKI 警报系统并未影响死亡率（调整后的 HR，1.07；95%CI，0.68-1.68）。