Holmes Jennifer, Roberts Gethin, Meran Soma, Williams John D, Phillips Aled O
Welsh Renal Clinical Network, Cwm Taf University Health Board, Caerphilly, UK.
Department of Clinical Biochemistry, Hywel Dda University Health Board, Aberystwyth, UK.
Kidney Int Rep. 2016 Dec 9;2(3):342-349. doi: 10.1016/j.ekir.2016.12.001. eCollection 2017 May.
Automated acute kidney injury (AKI) electronic alerts are based on comparing creatinine with historic results.
We report the significance of AKI defined by 3 "rules" differing in the time period from which the baseline creatinine is obtained, and AKI with creatinine within the normal range.
A total of 47,090 incident episodes of AKI occurred between November 2013 and April 2016. Rule 1 (>26 μmol/l increase in creatinine within 48 hours) accounted for 9.6%. Rule 2 (≥50% increase in creatinine within previous 7 days) and rule 3 (≥50% creatinine increase from the median value of results within the last 8-365 days) accounted for 27.3% and 63.1%, respectively. Hospital-acquired AKI was predominantly identified by rules 1 and 2 (71.7%), and community-acquired AKI (86.3%) by rule 3. Stages 2 and 3 were detected by rules 2 and 3. Ninety-day mortality was higher in AKI rule 2 (32.4%) than rule 1 (28.3%, < 0.001) and rule 3 (26.6%, < 0.001). Nonrecovery of renal function (90 days) was lower for rule 1 (7.9%) than rule 2 (22.4%, < 0.001) and rule 3 (16.5%, < 0.001). We found that 19.2% of AKI occurred with creatinine values within normal range, in which mortality was lower than that in AKI detected by a creatinine value outside the reference range (22.6% vs. 29.6%, < 0.001).
Rule 1 could only be invoked for stage 1 alerts and was associated with acute on chronic kidney disease acquired in hospital. Rule 2 was also associated with hospital-acquired AKI and had the highest mortality and nonrecovery. Rule 3 was the commonest cause of an alert and was associated with community-acquired AKI.
急性肾损伤（AKI）自动电子警报是基于将肌酐与历史结果进行比较。
我们报告了由3条“规则”定义的AKI的意义，这些规则在获取基线肌酐的时间段上有所不同，以及肌酐在正常范围内的AKI。
2013年11月至2016年4月期间共发生47090例AKI事件。规则1（48小时内肌酐升高>26μmol/l）占9.6%。规则2（前7天内肌酐升高≥50%）和规则3（较过去8 - 365天内结果的中位数肌酐升高≥50%）分别占27.3%和63.1%。医院获得性AKI主要由规则1和规则2识别（71.7%），社区获得性AKI由规则3识别（86.3%）。2期和3期由规则2和规则3检测到。AKI规则2的90天死亡率（32.4%）高于规则1（28.3%，<0.001）和规则3（26.6%，<0.001）。规则1的肾功能未恢复（90天）情况（7.9%）低于规则2（22.4%，<0.001）和规则3（16.5%，<0.001）。我们发现19.2%的AKI发生时肌酐值在正常范围内，其死亡率低于肌酐值超出参考范围检测到的AKI（22.6%对29.6%，<0.001）。
规则1仅用于1期警报，与医院获得的慢性肾脏病急性发作相关。规则2也与医院获得性AKI相关，且死亡率和未恢复率最高。规则3是警报最常见的原因，与社区获得性AKI相关。
