Del Carpio et al reported a model for predicting severe acute kidney injury (AKI) acquired by a hospitalized patient on a general hospital ward. This can help to identify a patient who may benefit from more aggressive management. The authors are from multiple institutions in Spain.
Patient selection: hospitalized patient not in intensive care unit (ICU), AKI stage 0 to 3
Outcome: severe AKI (increase in serum creatinine >= 3 times over baseline OR >= 4 mg/dL) with onset after the first 24 hours of admission
Parameters:
(1) age in years
(2) hypertension
(3) diabetes
(4) peripheral vascular disease
(5) anemia
(6) congestive heart failure
(7) ischemic heart disease
(8) chronic obstructive pulmonary disease (COPD)
(9) chronic liver disease
(10) chronic urologic disease
(11) CKD stage on admission
(12) SIRS vs shock
(13) acute heart failure
(14) major surgery
(15) acute respiratory failure
(16) nephrotoxic drugs
(17) exposure to contrast dyes
(18) urgent admission (probably includes emergency admission)
|
Parameter |
Finding |
Points |
|
age in years |
|
0.024 * (age) |
|
hypertension |
no |
0 |
|
|
yes |
0.539 |
|
diabetes |
no |
0 |
|
|
yes |
1.184 |
|
peripheral vascular disease |
no |
0 |
|
|
yes |
0.597 |
|
anemia |
no |
0 |
|
|
yes |
0.664 |
|
congestive heart failure |
no |
0 |
|
|
yes |
0.405 |
|
ischemic heart disease |
no |
0 |
|
|
yes |
0.653 |
|
COPD |
no |
0 |
|
|
yes |
0.469 |
|
chronic liver disease |
no |
0 |
|
|
yes |
1.013 |
|
chronic urologic disease |
no |
0 |
|
|
yes |
1.309 |
|
CKD stage |
none |
0 |
|
|
stage 1 |
0.582 |
|
|
stage 2 |
1.425 |
|
|
stage 3 |
2.187 |
|
SIRS or shock |
no |
0 |
|
|
SIRS |
0.698 |
|
|
shock |
2.055 |
|
acute heart failure |
no |
0 |
|
|
yes |
0.801 |
|
major surgery |
no |
0 |
|
|
yes |
1.213 |
|
acute respiratory failure |
no |
0 |
|
|
yes |
1.283 |
|
nephrotoxic drugs |
no |
0 |
|
|
yes |
0.345 |
|
exposure to contrast dyes |
no |
0 |
|
|
yes |
0.931 |
|
urgent admission |
no |
0 |
|
|
yes |
1.899 |
value of X =
= SUM(points for all of the parameters) - 11.211
probability of developing severe AKI =
= 1 / (1 + EXP((-1) * X))
Performance:
• The area under the ROC curve is 0.91.
