Hatakeyama Yutaka, Horino Taro, Nagata Keitaro, Kataoka Hiromi, Matsumoto Tatsuki, Terada Yoshio, Okuhara Yoshiyasu
Kochi Medical School, Center of Medical Information Science, Kochi University, Kohasu, Oko-cho, Nankoku, Kochi, Japan.
Department of Endocrinology, Metabolism and Nephrology, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan.
Clin Exp Nephrol. 2018 Apr;22(2):405-412. doi: 10.1007/s10157-017-1481-y. Epub 2017 Oct 5.
Modern epidemiologic studies of acute kidney injury (AKI) have been facilitated by the increasing availability of electronic medical records. However, pre-morbid reference serum creatinine (SCr) data are often unavailable in such records. Investigators substitute estimated baseline SCr with the eGFR 75 approach, instead of using actually measured baseline SCr. Here, we evaluated the accuracy of estimated baseline SCr for AKI diagnosis in the Japanese population.
Inpatients and outpatients aged 18-80 years were retrospectively enrolled. AKI was diagnosed according to the Kidney Disease Improving Global Outcomes (KDIGO) criteria, using SCr levels. The non-AKI and AKI groups were selected using the following criteria: increase 1.5 times greater than baseline SCr ("baseline SCr") or increase 0.3 mg/dL greater than baseline SCr in 48 h ("increase in 48 h"). AKI accuracy defined by the estimated reference SCr, the average SCr value of the non-AKI population (eb-GFR-A approach), or the back-calculated SCr from fixed eGFR = 75 mL/min/1.73 m (eGFR 75 approach, or, eb-GFR-B approach in this study), was evaluated.
We analyzed data from 131,358 Japanese patients. The number of patients with reference baseline SCr in the non-AKI and AKI patients were 29,834 and 8952, respectively. For AKI patients diagnosed using "baseline SCr", the AKI diagnostic accuracy rates as defined by eb-GFR-A and eb-GFR-B were 63.5 and 57.7%, respectively, while in AKI diagnosed using "increase in 48 h", the AKI diagnostic accuracy rates as defined by eb-GFR-A and eb-GFR-B were 78.7 and 75.1%, respectively. In non-AKI patients, false-positive rates of AKI misdiagnosed via eb-GFR-A and eb-GFR-B were 7.4 and 6.8%, respectively.
AKI diagnosis using the average SCr value of the general population may yield more accurate results than diagnosis using the eGFR 75 approach when the reference SCr is unavailable.
电子病历的日益普及推动了急性肾损伤（AKI）的现代流行病学研究。然而，此类记录中往往没有病前参考血清肌酐（SCr）数据。研究人员用估算的基线SCr替代实际测量的基线SCr，采用估算肾小球滤过率（eGFR）75的方法，而非实际测量的基线SCr。在此，我们评估了日本人群中估算基线SCr用于AKI诊断的准确性。
回顾性纳入年龄在18至80岁的住院患者和门诊患者。根据改善全球肾脏病预后组织（KDIGO）标准，使用SCr水平诊断AKI。非AKI组和AKI组按以下标准选取：较基线SCr升高1.5倍以上（“基线SCr”）或在48小时内较基线SCr升高0.3mg/dL以上（“48小时内升高”）。评估由估算参考SCr、非AKI人群的平均SCr值（eb-GFR-A方法）或根据固定eGFR = 75 mL/min/1.73m反推计算的SCr（eGFR 75方法，本研究中即eb-GFR-B方法）所定义的AKI诊断准确性。
我们分析了131358例日本患者的数据。非AKI患者和AKI患者中有参考基线SCr的患者数量分别为29834例和8952例。对于使用“基线SCr”诊断的AKI患者，eb-GFR-A和eb-GFR-B所定义的AKI诊断准确率分别为63.5%和57.7%，而对于使用“48小时内升高”诊断的AKI患者，eb-GFR-A和eb-GFR-B所定义的AKI诊断准确率分别为78.7%和75.1%。在非AKI患者中，通过eb-GFR-A和eb-GFR-B误诊为AKI的假阳性率分别为7.4%和6.8%。
当参考SCr不可用时，使用普通人群的平均SCr值诊断AKI可能比使用eGFR 75方法诊断产生更准确的结果。
