Systematic review of prognostic prediction models for acute kidney injury (AKI) in general hospital populations - PubMed (original) (raw)

Systematic review of prognostic prediction models for acute kidney injury (AKI) in general hospital populations

Luke Eliot Hodgson et al. BMJ Open. 2017.

Abstract

Objective: Critically appraise prediction models for hospital-acquired acute kidney injury (HA-AKI) in general populations.

Design: Systematic review.

Data sources: Medline, Embase and Web of Science until November 2016.

Eligibility: Studies describing development of a multivariable model for predicting HA-AKI in non-specialised adult hospital populations. Published guidance followed for data extraction reporting and appraisal.

Results: 14 046 references were screened. Of 53 HA-AKI prediction models, 11 met inclusion criteria (general medicine and/or surgery populations, 474 478 patient episodes) and five externally validated. The most common predictors were age (n=9 models), diabetes (5), admission serum creatinine (SCr) (5), chronic kidney disease (CKD) (4), drugs (diuretics (4) and/or ACE inhibitors/angiotensin-receptor blockers (3)), bicarbonate and heart failure (4 models each). Heterogeneity was identified for outcome definition. Deficiencies in reporting included handling of predictors, missing data and sample size. Admission SCr was frequently taken to represent baseline renal function. Most models were considered at high risk of bias. Area under the receiver operating characteristic curves to predict HA-AKI ranged 0.71-0.80 in derivation (reported in 8/11 studies), 0.66-0.80 for internal validation studies (n=7) and 0.65-0.71 in five external validations. For calibration, the Hosmer-Lemeshow test or a calibration plot was provided in 4/11 derivations, 3/11 internal and 3/5 external validations. A minority of the models allow easy bedside calculation and potential electronic automation. No impact analysis studies were found.

Conclusions: AKI prediction models may help address shortcomings in risk assessment; however, in general hospital populations, few have external validation. Similar predictors reflect an elderly demographic with chronic comorbidities. Reporting deficiencies mirrors prediction research more broadly, with handling of SCr (baseline function and use as a predictor) a concern. Future research should focus on validation, exploration of electronic linkage and impact analysis. The latter could combine a prediction model with AKI alerting to address prevention and early recognition of evolving AKI.

Keywords: acute kidney injury; clinical prediction models; systematic review.

© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1

Figure 1

PRISMA study flow chart. AKI, acute kidney injury; PRISMA, Preferred Reporting Items for Systematic Review and Meta-Analysis.

Figure 2

Figure 2

Predictors most frequently included in the 11 HA-AKI prediction models. ACEi, ACE inhibitors; ARBs, angiotensin-receptor blockers; Bloods, laboratory parameters; CKD, chronic kidney disease; HA-AKI, hospital-acquired acute kidney injury; ↓HCO3, reduced serum bicarbonate; SCr, serum creatinine; ↑WCC, raised white cell count.

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