Comparison of Three Methods Estimating Baseline Creatinine For Acute Kidney Injury in Hospitalized Patients: a Multicentre Survey in Third-Level Urban Hospitals of China

Lang, Xiabing; Yang, Yi; Yang, Jing; Wan, Jianxin; Yu, Shengqiang; Cui, Jiong; Tang, Xiaojing; Chen, Jianghua

doi:10.1159/000487366

Cited by 5 publications

(8 citation statements)

References 30 publications

(45 reference statements)

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“…Our results were consistent with previous studies, reporting that first SCr value or assumed eGFR of 75 mL/min per 1.73 m 2 , in exchange of reduced selection bias and feasibility, may lead to misclassification in AKI diagnosis and staging [12, 19, 20]. These limitations have been recognized; nevertheless, the use of the surrogates is still widespread in AKI research [21-25].…”

Section: Discussionsupporting

confidence: 90%

Estimation of Missing Baseline Serum Creatinine for Acute Kidney Injury Diagnosis in Hospitalized Patients

Laszczyńska

Severo

Correia

et al. 2020

Nephron

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Introduction: In hospitalized patients, information on preadmission kidney function is often missing, impeding timely and accurate acute kidney injury (AKI) detection and affecting results of AKI-related studies. Objective: In this study, we provided estimates of preadmission serum creatinine (SCr), based on a multivariate linear regression (Model 1) and random forest model (Model 2) built with different parametrizations. Their accuracy for AKI diagnosis was compared with the accuracy of commonly used surrogate methods: (i) SCr at hospital admission (first SCr) and (ii) SCr back-calculated from the assumed estimated glomerular filtration rate of 75 mL/min/1.73 m2 (eGFR 75). Methods: From 44,670 unique adult admissions to a tertiary referral centre between 2013 and 2015, we analysed 8,540 patients with preadmission SCr available. To control for differences in characteristics of patients with and without SCr, we used an inverse probability weighting technique. Results: Estimates of SCr were likely to be higher than true preadmission SCr in a low Cr concentration and undervalued in high concentrations although for Model 2 Complete-SCr these differences were smallest. The true cumulative incidence of AKI was 14.8%. Model 2 Complete-SCr had the best agreement for AKI diagnosis (kappa 0.811, 95% CI 0.787–0.835), while surrogate methods resulted in the lowest agreement: (kappa 0.553, 0.516–0.590) and (0.648, 0.620–0.676) for first SCr and eGFR 75, respectively. Conclusions: Multivariable imputation of preadmission SCr, taking into account elementary admission data, improved accuracy in AKI diagnosis over commonly used surrogate methods. Random forest-based models can serve as an effective tool in research.

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Section: Discussionsupporting

confidence: 90%

Estimation of Missing Baseline Serum Creatinine for Acute Kidney Injury Diagnosis in Hospitalized Patients

Laszczyńska

Severo

Correia

et al. 2020

Nephron

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“…However, mSCr-base is missing for up to 50% of patients, which makes the accurate evaluation of AKI and associated clinical outcomes difficult [ 12 , 13 , 31 ]. For patients without mSCr-base data, several previous studies in adults have evaluated different estimation methods [ 13 , 15 , 16 , 18 , 32 ], but the pediatric and adult populations differ in several important, relevant ways. The most widely used approach in the adult population is the imputation method with the MDRD equation, which assumes an eGFR of 75 mL/min/1.73 m 2 [ 13 , 16 , 33 ].…”

Section: Discussionmentioning

confidence: 99%

“…For patients without mSCr-base data, several previous studies in adults have evaluated different estimation methods [ 13 , 15 , 16 , 18 , 32 ], but the pediatric and adult populations differ in several important, relevant ways. The most widely used approach in the adult population is the imputation method with the MDRD equation, which assumes an eGFR of 75 mL/min/1.73 m 2 [ 13 , 16 , 33 ]. However, the MDRD equation is inappropriate in children because the normal reference eGFR differs by age, and the age- and growth-dependent reference ranges for SCr and eGFR values in pediatric patients are wide [ 21 , 23 , 34 , 35 ].…”

Section: Discussionmentioning

confidence: 99%

“…SCr-min was another eSCr-base method used in this study. Although a strong consensus exists that the lowest SCr value should be used for the SCr-min calculation, the duration within which the lowest SCr value is determined varies among the relevant studies, ranging from the whole hospitalization period to 2 weeks or 3 days after PICU admission [ 11 , 13 , 16 , 17 , 31 , 32 , 37 ]. In this study, SCr-min was defined as the lowest SCr value measured within 7 days after PICU admission for the following reasons.…”

Section: Discussionmentioning

confidence: 99%

“…In the absence of consensus-based standardized methods for replacing missing SCr-base data, several values have been suggested for estimating a surrogate SCr-base value, including the initial admission SCr values, minimum SCr values during hospitalization, dynamic SCr values during a 7-day or 48-hour window, or back-calculation by imputing an estimated GFR (eGFR) of 75 mL/min/1.73 m 2 with the Modification of Diet in Renal Disease (MDRD) equation or the Chronic Kidney Disease Epidemiology Collaboration formula [13,[15][16][17][18][19][20]. However, those substitutes have mainly been studied and validated in adult populations.…”

Section: Introductionmentioning

confidence: 99%

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Estimating baseline creatinine values to define acute kidney injury in critically ill pediatric patients

Lee

Park

Jhang

2022

Kidney Res Clin Pract

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Background: Acute kidney injury (AKI) is a common complication in critically ill children. However, the common lack of baseline serum creatinine values affects AKI diagnosis and staging. Several approaches for estimating baseline creatinine values in those patients were evaluated. Methods: This single-center retrospective study enrolled pediatric patients with documented serum creatinine measurements within 3 months before admission and more than two serum creatinine measurements within 7 days after admission to the pediatric intensive care unit of a tertiary care children's hospital between January 2016 and April 2020. Four different approaches for estimating AKI using serum creatinine measurements were compared: 1) back-calculation using age-adjusted normal reference glomerular filtration rates, 2) age-adjusted normal reference serum creatinine values, 3) minimum values measured within 7 days after admission, and 4) initial values upon admission. Results: The approach using minimum values showed the best agreement with the measured baseline value, with the largest intraclass correlation coefficient (0.623), smallest bias (-0.04), and narrowest limit of agreement interval (1.032). For AKI diagnosis and staging, the minimum values were 80.8% and 76.1% accurate, respectively. The other estimated baseline values underestimated AKI and showed poor agreement with baseline values before admission, with a misclassification rate of up to 42% (p < 0.001). Conclusion: Minimum values of serum creatinine measured within 7 days after hospital admission showed the best agreement with creatinine measured within 3 months before admission, indicating the possibility of using it as a baseline when baseline data are unavailable. Further large-scale studies are required to accurately diagnose AKI in critically ill children.

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Modification of Pediatric Sequential Organ Failure Assessment Score Using Acute Kidney Injury Diagnostic Criteria

Jhang

Kim

et al. 2020

Pediatric Critical Care Medicine

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Objectives: To develop a modified pediatric Sequential Organ Failure Assessment score using the acute kidney injury diagnostic criteria and evaluate its performance in predicting mortality. Design: A single-center retrospective study. Setting: Fourteen-bed PICU in a tertiary care academic children’s hospital. Patients: Critically ill children admitted to the PICU between January 2017 and September 2019 with at least more than two serum creatinine measurements—one for baseline and the other within the first 48 hours of PICU admission. Interventions: None. Measurements and Main Results: A total of 755 patients were included. Overall, 265 patients were diagnosed with acute kidney injury using the current acute kidney injury diagnostic criteria. The overall PICU mortality was 5.8%. Patients with acute kidney injury required more vasoactive-inotropic drugs and showed higher illness severity scores, including the Pediatric Risk of Mortality III, Pediatric Logistic Organ Dysfunction 2, pediatric Sequential Organ Failure Assessment, and modified pediatric Sequential Organ Failure Assessment scores, as well as higher PICU mortality than patients without acute kidney injury (p < 0.001). As acute kidney injury stages increase, PICU mortality also increased (p < 0.001). Based on multivariable logistic regression analysis adjusted for age and sex, the modified pediatric Sequential Organ Failure Assessment score was an independent prognostic factor of PICU mortality. The modified pediatric Sequential Organ Failure Assessment score showed better performance in predicting PICU mortality (area under the receiver operating characteristic curve, 0.821; 95% CI, 0.759–0.882) than other severity scores (area under the receiver operating characteristic curve [95% CI] of Pediatric Risk of Mortality III, Pediatric Logistic Organ Dysfunction 2, and pediatric Sequential Organ Failure Assessment scores: 0.788 [0.723–0.853], 0.735 [0.663–0.807], and 0.785 [0.718–0.853], respectively). Conclusions: Acute kidney injury is prevalent and associated with poor clinical outcomes in critically ill children. The modified pediatric Sequential Organ Failure Assessment score, based on the acute kidney injury diagnostic criteria, showed improved performance in predicting PICU mortality. The modified pediatric Sequential Organ Failure Assessment score could be a promising prognostic factor for critically ill children.

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Comparison of Three Methods Estimating Baseline Creatinine For Acute Kidney Injury in Hospitalized Patients: a Multicentre Survey in Third-Level Urban Hospitals of China

Cited by 5 publications

References 30 publications

Estimation of Missing Baseline Serum Creatinine for Acute Kidney Injury Diagnosis in Hospitalized Patients

Estimation of Missing Baseline Serum Creatinine for Acute Kidney Injury Diagnosis in Hospitalized Patients

Estimating baseline creatinine values to define acute kidney injury in critically ill pediatric patients

Modification of Pediatric Sequential Organ Failure Assessment Score Using Acute Kidney Injury Diagnostic Criteria

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