D'Arienzo David, Hessey Erin, Ali Rami, Perreault Sylvie, Samuel Susan, Roy Louise, Lacroix Jacques, Jouvet Philippe, Morissette Genevieve, Dorais Marc, Lafrance Jean-Philippe, Phan Veronique, Pizzi Michael, Chanchlani Rahul, Zappitelli Michael
Faculty of Medicine, McGill University, Montreal, QC, Canada.
Faculty of Medicine, University of Alberta, Edmonton, Canada.
Can J Kidney Health Dis. 2019 Feb 10;6:2054358119827525. doi: 10.1177/2054358119827525. eCollection 2019.
Large studies evaluating pediatric acute kidney injury (AKI) epidemiology and outcomes are lacking, partially due to underuse of large administrative health care data.
To assess the diagnostic accuracy of administrative health care data-defined AKI in children admitted to the pediatric intensive care unit (PICU).
Retrospective cohort study utilizing chart and administrative data.
Children admitted to the PICU at 2 centers in Montreal, QC.
Patients between 0 and 18 years old with a provincial health insurance number, without end-stage renal disease and admitted to the PICU between January 1, 2003, and March 31, 2005, were included.
The AKI was defined from chart data using the Kidney Disease: Improving Global Outcomes (KDIGO) definition (Chart-AKI). The AKI defined using administrative health data (Admin-AKI) was based on () AKI codes.
Data available from retrospective chart review, including baseline and PICU patient characteristics, and serum creatinine (SCr) and urine output (UO) values during PICU admission, were merged with provincial administrative health care data containing diagnostic and procedure codes used for ascertaining Admin-AKI. Sensitivity, specificity, positive, and negative predictive value of Admin-AKI compared with Chart-AKI (reference standard) were calculated. Univariable associations between Admin-AKI and hospital mortality were evaluated.
A total of 2051 patients (55% male, mean age at admission 6.1 ± 5.8 years, 355 cardiac surgery, 1696 noncardiac surgery) were included. The AKI defined by SCr or UO criteria occurred in 52% of cardiac surgery patients and 24% of noncardiac surgery patients. Overall, Admin-AKI detected Chart-AKI with low sensitivity, but high specificity in cardiac and noncardiac surgery patients. Sensitivity increased by 1.5 to 2 fold with each increase in AKI severity stage. Admin-AKI was associated with hospital mortality (13% in Admin-AKI 2% in non-AKI, < .001).
These data were generated in a PICU population; future research should study non-PICU populations.
Use of administrative health care data to define AKI in children leads to AKI incidence underestimation. However, for detecting more severe AKI, sensitivity is higher, while maintaining high specificity.
目前缺乏评估儿童急性肾损伤（AKI）流行病学及预后的大型研究，部分原因是大型医疗管理数据未得到充分利用。
评估医疗管理数据定义的AKI在儿科重症监护病房（PICU）住院儿童中的诊断准确性。
利用病历和管理数据进行的回顾性队列研究。
魁北克省蒙特利尔市2家中心的PICU收治的儿童。
纳入2003年1月1日至2005年3月31日期间入住PICU、年龄在0至18岁、拥有省级医疗保险编号且无终末期肾病的患者。
根据病历数据，采用改善全球肾脏病预后组织（KDIGO）的定义确定AKI（病历定义的AKI）。利用医疗管理数据定义的AKI（管理数据定义的AKI）基于（）AKI编码。
将回顾性病历审查获得的数据，包括基线和PICU患者特征，以及PICU住院期间的血清肌酐（SCr）和尿量（UO）值，与包含用于确定管理数据定义的AKI的诊断和操作编码的省级医疗管理数据合并。计算管理数据定义的AKI与病历定义的AKI（参考标准）相比的灵敏度、特异度、阳性预测值和阴性预测值。评估管理数据定义的AKI与医院死亡率之间的单变量关联。
共纳入2051例患者（55%为男性，入院时平均年龄6.1±5.8岁，355例行心脏手术，1696例行非心脏手术）。根据SCr或UO标准定义诊断的AKI在52%的心脏手术患者和24%的非心脏手术患者中出现。总体而言，管理数据定义的AKI检测病历定义的AKI时灵敏度较低，但在心脏和非心脏手术患者中特异度较高。随着AKI严重程度分期每增加一级，灵敏度增加1.5至2倍。管理数据定义的AKI与医院死亡率相关（管理数据定义的AKI患者中为13%，非AKI患者中为2%，P<.001）。
这些数据来自PICU人群；未来研究应针对非PICU人群展开。
利用医疗管理数据定义儿童AKI会导致AKI发病率被低估。然而，对于检测更严重的AKI，灵敏度较高，同时保持较高的特异度。
