Studies of acute kidney injury (AKI) commonly lack data on pre-admission renal function, often substituting an inpatient or imputed serum creatinine (SCr) as an estimate for “baseline” renal function. We examined the error introduced when applying methods to estimate “baseline” on AKI classification and mortality. Within a cohort of 4863 adults with a known outpatient baseline admitted to Vanderbilt University Hospital between 10/07 and 10/08, the following surrogates were studied: (1) an eGFR of 75 ml/min/1.73m2 as suggested by the Acute Dialysis Quality Initiative (ADQI), (2) a minimum inpatient SCr, and (3) the first admission SCr. We calculated AKI incidence and mortality rates using each surrogate, and assessed their ability to correctly classify AKI incidence and mortality compared to the most recent outpatient SCr between 7-365 days before admission. Using both imputed and minimum baseline SCr values inflated AKI incidence (38.3% and 35.9% vs. 25.5%; p<0.001), reflecting low specificities of 77% and 80%, respectively. In contrast, using an admission SCr baseline underestimated AKI incidence (13.7% vs. 25.5%, p<0.001), demonstrating a low sensitivity of 39%. Using any surrogate led to frequent misclassification of patient deaths as following AKI and differences for both in-hospital and 60-day mortality rates. In summary, commonly used surrogates for baseline SCr result in bi-directional misclassification of AKI incidence and prognosis in a hospitalized setting.
This review suggests a good prognosis for children with clinically amyopathic DM. A minority of patients with negative muscle enzymes had positive ancillary testing for myositis, and these patients rarely developed muscle weakness. Predictive factors for progression to classical DM were not identified. Symptomatic treatment of cutaneous involvement and close clinical monitoring may be an alternative to aggressive immunosuppression.
More than 4 years after the official end of war, the crude mortality rate remains elevated across DRC. Slight but significant improvements in mortality in the insecure east coincided temporally with recent progress on security, humanitarian, and political fronts.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.