External Validation for Acute Kidney Injury Severity Scores: A Multicenter Retrospective Study in 14 Japanese ICUs

Abstract

Background/Aims: Acute kidney injury (AKI) is associated with high mortality. Multiple AKI severity scores have been derived to predict patient outcome. We externally validated new AKI severity scores using the Japanese Society for Physicians and Trainees in Intensive Care (JSEPTIC) database. Methods: New AKI severity scores published in the 21st century (Mehta, Stuivenberg Hospital Acute Renal Failure (SHARF) II, Program to Improve Care in Acute Renal Disease (PICARD), Vellore and Demirjian), Liano, Simplified Acute Physiology Score (SAPS) II and lactate were compared using the JSEPTIC database that collected retrospectively 343 patients with AKI who required continuous renal replacement therapy (CRRT) in 14 intensive care units. Accuracy of the severity scores was assessed by the area under the receiver-operator characteristic curve (AUROC, discrimination) and Hosmer-Lemeshow test (H-L test, calibration). Results: The median age was 69 years and 65.8% were male. The median SAPS II score was 53 and the hospital mortality was 58.6%. The AUROC curves revealed low discrimination ability of the new AKI severity scores (Mehta 0.65, SHARF II 0.64, PICARD 0.64, Vellore 0.64, Demirjian 0.69), similar to Liano 0.67, SAPS II 0.67 and lactate 0.64. The H-L test also demonstrated that all assessed scores except for Liano had significantly low calibration ability. Conclusions: Using a multicenter database of AKI patients requiring CRRT, this study externally validated new AKI severity scores. While the Demirjian's score and Liano's score showed a better performance, further research will be required to confirm these findings.

Sepsis associated acute kidney injury

“…The performances of non-specific AKI risk scores and other critical illness scores have been disappointing in patients with SA-AKI 66. A retrospective study investigated the performance of several risk scores (Liano,63 Simplified Acute Physiology Score II,66 PICARD,37 and Demirjan64) to detect SA-AKI in 343 patients requiring continuous RRT, but no score provided an area under the curve (AUC) greater than 0.70 67. A multicenter study of 214 pediatric ICU patients with sepsis assessed the ability of a renal angina index (RAI) and other novel biomarkers to predict SA-AKI 68.…”

Predicting acute kidney injury prognosis

“…Of note, being of black race was associated with improved outcomes. In a retrospective analysis of patients admitted to 14 Japanese ICUs requiring continuous renal replacement therapy, Ohnuma and colleagues [39] externally validated 6 predictive models. Unfortunately, each of these models provided poor discrimination.…”

The National Early Warning Score and its subcomponents recorded within ±24 h of emergency medical admission are poor predictors of hospital-acquired acute kidney injury

“…The National Confidential Enquiry into Patient Outcome and Death highlighted systematic failings of identification and management of AKI in hospitals and recommended that all emergency admissions should be screened for early detection of AKI. 1,2 Therefore, an AKI risk assessment tool could be helpful and has been developed for use with intensive care, [3][4][5] adult cardiac surgery, 6,7 paediatric cardiac surgery 8 and general surgery 9,10 patients; however, no such tool has been developed for those patients admitted as an emergency who mostly stay on general wards. Although changes in serum creatinine level and urine output are indicators of risk, it is important that these biomarkers are monitored alongside a 'track and trigger' system 1 to enable early recognition and effective treatment.…”