Cooper Daniel J, Plewes Katherine, Grigg Matthew J, Patel Aatish, Rajahram Giri S, William Timothy, Hiemstra Thomas F, Wang Zhiqiang, Barber Bridget E, Anstey Nicholas M
Menzies School of Health Research and Charles Darwin University, Darwin, Northern Territory, Australia.
Infectious Diseases Society Sabah-Menzies School of Health Research Clinical Research Unit, Kota Kinabalu, Sabah, Malaysia.
Kidney Int Rep. 2021 Jan 1;6(3):645-656. doi: 10.1016/j.ekir.2020.12.020. eCollection 2021 Mar.
Classification of acute kidney injury (AKI) requires a premorbid baseline creatinine, often unavailable in studies in acute infection.
We evaluated commonly used surrogate and imputed baseline creatinine values against a "reference" creatinine measured during follow-up in an adult clinical trial cohort. Known AKI incidence (Kidney Disease: Improving Global Outcomes [KDIGO] criteria) was compared with AKI incidence classified by (1) back-calculation using the Modification of Diet in Renal Disease (MDRD) equation with and without a Chinese ethnicity correction coefficient; (2) back-calculation using the Chronic Kidney Disease-Epidemiology Collaboration (CKD-EPI) equation; (3) assigning glomerular filtration rate (GFR) from age and sex-standardized reference tables; and (4) lowest measured creatinine during admission. Back-calculated distributions were performed using GFRs of 75 and 100 ml/min.
All equations using an assumed GFR of 75 ml/min underestimated AKI incidence by more than 50%. Back-calculation with CKD-EPI and GFR of 100 ml/min most accurately predicted AKI but misclassified all AKI stages and had low levels of agreement with true AKI diagnoses. Back-calculation using MDRD and assumed GFR of 100 ml/min, age and sex-reference GFR values adjusted for good health, and lowest creatinine during admission performed similarly, best predicting AKI incidence (area under the receiver operating characteristic curves [AUC ROCs] of 0.85, 0.87, and 0.85, respectively). MDRD back-calculation using a cohort mean GFR showed low total error (22%) and an AUC ROC of 0.85.
Current methods for estimating baseline creatinine are large sources of potential error in acute infection studies. Preferred alternatives include MDRD equation back-calculation with a population mean GFR, age- and sex-specific GFR values corrected for "good health," or lowest measured creatinine. Studies using surrogate baseline creatinine values should report specific methodology.
急性肾损伤（AKI）的分类需要病前的肌酐基线值，但在急性感染研究中往往无法获取。
在一项成人临床试验队列中，我们将常用的替代和推算基线肌酐值与随访期间测得的“参考”肌酐值进行了评估。将已知的AKI发病率（肾脏病：改善全球预后[KDIGO]标准）与通过以下方法分类的AKI发病率进行比较：（1）使用肾脏病饮食改良（MDRD）方程进行反向计算，有无中国种族校正系数；（2）使用慢性肾脏病流行病学协作组（CKD-EPI）方程进行反向计算；（3）根据年龄和性别标准化参考表指定肾小球滤过率（GFR）；（4）入院期间测得的最低肌酐值。使用75和100 ml/min的GFR进行反向计算分布。
所有使用假定GFR为75 ml/min的方程均将AKI发病率低估了50%以上。使用CKD-EPI和GFR为100 ml/min进行反向计算最准确地预测了AKI，但对所有AKI阶段进行了错误分类，并且与真正的AKI诊断的一致性水平较低。使用MDRD并假定GFR为100 ml/min、根据健康状况调整的年龄和性别参考GFR值以及入院期间最低肌酐值进行反向计算的结果相似，对AKI发病率的预测最佳（受试者工作特征曲线下面积[AUC ROC]分别为0.85、0.87和0.85）。使用队列平均GFR的MDRD反向计算显示总误差较低（22%），AUC ROC为0.85。
目前估算基线肌酐的方法是急性感染研究中潜在误差的重要来源。首选的替代方法包括使用总体平均GFR的MDRD方程反向计算、针对“健康状况”校正的年龄和性别特异性GFR值或测得的最低肌酐值。使用替代基线肌酐值的研究应报告具体方法。
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