Department of Nephrology, First Medical Center of Chinese PLA General Hospital, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Diseases Research, Beijing, 100853, China.
First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China.
BMC Med. 2024 Sep 20;22(1):408. doi: 10.1186/s12916-024-03639-x.
Although electronic alerts are being increasingly implemented in patients with acute kidney injury (AKI), their effect remains unclear. Therefore, we conducted this meta-analysis aiming at investigating their impact on the care and outcomes of AKI patients.
PubMed, Embase, Cochrane Library, and Clinical Trial Registries databases were systematically searched for relevant studies from inception to March 2024. Randomized controlled trials comparing electronic alerts with usual care in patients with AKI were selected.
Six studies including 40,146 patients met the inclusion criteria. The pooled results showed that electronic alerts did not improve mortality rates (relative risk (RR) = 1.02, 95% confidence interval (CI) = 0.97-1.08, P = 0.44) or reduce creatinine levels (mean difference (MD) = - 0.21, 95% CI = - 1.60-1.18, P = 0.77) and AKI progression (RR = 0.97, 95% CI = 0.90-1.04, P = 0.40). Instead, electronic alerts increased the odds of dialysis and AKI documentation (RR = 1.14, 95% CI = 1.05-1.25, P = 0.002; RR = 1.21, 95% CI = 1.01-1.44, P = 0.04, respectively), but the trial sequential analysis (TSA) could not confirm these results. No differences were observed in other care-centered outcomes including renal consults and investigations between the alert and usual care groups.
Electronic alerts increased the incidence of AKI and dialysis in AKI patients, which likely reflected improved recognition and early intervention. However, these changes did not improve the survival or kidney function of AKI patients. The findings warrant further research to comprehensively evaluate the impact of electronic alerts.
尽管电子警报在急性肾损伤 (AKI) 患者中被越来越多地应用，但它们的效果仍不清楚。因此，我们进行了这项荟萃分析，旨在研究它们对 AKI 患者的护理和结局的影响。
从建库到 2024 年 3 月，系统地检索了 PubMed、Embase、Cochrane 图书馆和临床试验注册库中的相关研究。选择了比较 AKI 患者电子警报与常规护理的随机对照试验。
纳入了 6 项研究，共 40146 名患者。汇总结果显示，电子警报并未改善死亡率（相对风险 (RR) = 1.02，95%置信区间 (CI) = 0.97-1.08，P = 0.44）或降低肌酐水平（均数差 (MD) = -0.21，95%CI = -1.60-1.18，P = 0.77）和 AKI 进展（RR = 0.97，95%CI = 0.90-1.04，P = 0.40）。相反，电子警报增加了透析和 AKI 记录的几率（RR = 1.14，95%CI = 1.05-1.25，P = 0.002；RR = 1.21，95%CI = 1.01-1.44，P = 0.04），但试验序贯分析 (TSA) 无法确认这些结果。在警报和常规护理组之间，其他以护理为中心的结局（包括肾脏咨询和检查）没有差异。
电子警报增加了 AKI 患者 AKI 和透析的发生率，这可能反映了识别和早期干预的改善。然而，这些变化并没有改善 AKI 患者的生存率或肾功能。这些发现需要进一步研究，以全面评估电子警报的影响。
