Risk of postoperative acute kidney injury in patients undergoing orthopaedic surgery--development and validation of a risk score and effect of acute kidney injury on survival: observational cohort study

Bell, Samira; Dekker, Friedo W.; Vadiveloo, Thenmalar; Marwick, Charis; Deshmukh, Harshal; Donnan, Peter T.; Diepen, Merel van

doi:10.1136/bmj.h5639

Cited by 139 publications

(149 citation statements)

References 42 publications

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“…Previous studies have also noted effect modification by baseline function12, 32, 33 and a diminishing role of AKI after hospital discharge 34, 35. This analysis now shows that the diminishing role of AKI continues for up to 1 year after AKI and is present at all levels of baseline kidney function.…”

Section: Discussionsupporting

confidence: 68%

Intermediate and Long-term Outcomes of Survivors of Acute Kidney Injury Episodes: A Large Population-Based Cohort Study

Sawhney

Marks

Fluck

et al. 2017

American Journal of Kidney Diseases

198

189

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BackgroundThe long-term prognosis after acute kidney injury (AKI) is variable. It is unclear how the prognosis of AKI and its relationship to prognostic factors (baseline kidney function, AKI severity, prior AKI episodes, and recovery of kidney function) change as follow-up progresses.Study DesignObservational cohort study.Setting & ParticipantsThe Grampian Laboratory Outcomes Morbidity and Mortality Study II (GLOMMS-II) is a large regional population cohort with complete serial biochemistry and outcome data capture through data linkage. From GLOMMS-II, we followed up 17,630 patients hospitalized in 2003 through to 2013.PredictorsAKI identified using KDIGO (Kidney Disease: Improving Global Outcomes) serum creatinine criteria, characterized by baseline kidney function (estimated glomerular filtration rate [eGFR] ≥ 60, 45-59, 30-44, and <30 mL/min/1.73 m2), AKI severity (KDIGO stage), 90-day recovery of kidney function, and prior AKI episodes.OutcomesIntermediate- (30-364 days) and long-term (1-10 years) mortality and long-term renal replacement therapy.MeasurementsPoisson regression in time discrete intervals. Multivariable Cox regression for those at risk in the intermediate and long term, adjusted for age, sex, baseline comorbid conditions, and acute admission circumstances.ResultsOf 17,630 patients followed up for a median of 9.0 years, 9,251 died. Estimated incidences of hospital AKI were 8.4% and 17.6% for baseline eGFRs ≥ 60 and <60 mL/min/1.73 m2, respectively. Intermediate-term (30-364 days) adjusted mortality HRs for AKI versus no AKI were 2.48 (95% CI, 2.15-2.88), 2.50 (95% CI, 2.04-3.06), 1.90 (95% CI, 1.51-2.39), and 1.63 (95% CI, 1.20-2.22) for eGFRs ≥ 60, 45 to 59, 30 to 44, and <30 mL/min/1.73 m2, respectively. Among 1-year survivors, long-term HRs were attenuated: 1.44 (95% CI, 1.31-1.58), 1.25 (95% CI, 1.09-1.43), 1.21 (95% CI, 1.03-1.42), and 1.08 (95% CI, 0.85-1.36), respectively. The excess long-term hazards in AKI were lower for lower baseline eGFRs (P for interaction = 0.01).LimitationsNonprotocolized observational data. No adjustment for albuminuria.ConclusionsThe prognostic importance of a discrete AKI episode lessens over time. Baseline kidney function is of greater long-term importance.

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Section: Discussionsupporting

confidence: 68%

Intermediate and Long-term Outcomes of Survivors of Acute Kidney Injury Episodes: A Large Population-Based Cohort Study

Sawhney

Marks

Fluck

et al. 2017

American Journal of Kidney Diseases

198

189

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“…Bell et al found women to be 50% less likely to develop AKI after undergoing orthopedic surgery. 30 Similarly, in a study of postoperative general surgery patients, women were noted to be 40% less likely to develop AKI. 31 Although the complete mechanism is not well understood, animal models suggest that estrogen might be responsible for protecting the kidney from ischemic injury.…”

Section: Discussionmentioning

confidence: 95%

Sex differences in utilization and outcomes of catheter-directed thrombolysis in patients with proximal lower extremity deep venous thrombosis – Insights from the Nationwide Inpatient Sample

et al. 2017

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Catheter-directed thrombolysis (CDT) is being increasingly used for the treatment of proximal lower extremity (LE) deep venous thrombosis (DVT). However, sex differences in utilization and safety outcomes of CDT in these patients are unknown. The Nationwide Inpatient Sample (NIS) database was used to identify all patients with a principal discharge diagnosis of proximal LE or caval DVT who underwent CDT between January 2005 and December 2011 in the United States. We evaluated the comparative safety outcomes of CDT among a propensity-matched group of 1731 men versus 1731 women. Among 108,243 patients with proximal LE or caval DVT, 4826 patients (4.5%) underwent CDT. Overall, women underwent CDT less often compared to men (4.1% vs 4.9%, p<0.01, respectively). The rates of CDT increased between 2005 and 2011 for both women (2.1% to 5.9%, p<0.01) and men (2.5% to 7.5%, p<0.01). There was no significant difference in in-hospital mortality (1.2% vs 1.3%, p=0.76). Women were noted to have higher rates of blood transfusions (11.7% vs 8.8%, p<0.01), but lower rates of intracranial hemorrhage (0.5% vs 1.2%, p=0.03) and gastrointestinal bleeding (0.9% vs 2.2%, p<0.01) compared with men. Women were more likely to undergo inferior vena cava filter placement (37.0% vs 32.1%, p<0.01). In this large nationwide cohort, women with proximal DVT were less likely to receive CDT compared to men. Although mortality rates were similar, women were noted to have higher blood transfusion rates while men had more episodes of intracranial and gastrointestinal bleeding.

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“…In AKI predictive modeling, logistic regression with backward or forward selection (wrapper method) is often used to select a subset of features for model building 7 ; chi-squared test (filter) 8 , random forest (embedded) 9 , and gradient boosting machine (embedded) 10 have also been applied to illustrate the feature importance and ranking in AKI prediction. With the increasing variety of feature selection methods and their frequent utilization in the health informatics research community, new questions arise, namely there is no systematic way to choose the most appropriate feature selection method for a given domain and problem, which often depends on two aspects 11 : (a) the stability of FS ranking with respect to different samples, and (b) the prediction accuracy of FS subset effectively representing the entire data.…”

Section: Introductionmentioning

confidence: 99%

Feature Ranking in Predictive Models for Hospital-Acquired Acute Kidney Injury

Liu

et al. 2018

Sci Rep

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Acute Kidney Injury (AKI) is a common complication encountered among hospitalized patients, imposing significantly increased cost, morbidity, and mortality. Early prediction of AKI has profound clinical implications because currently no treatment exists for AKI once it develops. Feature selection (FS) is an essential process for building accurate and interpretable prediction models, but to our best knowledge no study has investigated the robustness and applicability of such selection process for AKI. In this study, we compared eight widely-applied FS methods for AKI prediction using nine-years of electronic medical records (EMR) and examined heterogeneity in feature rankings produced by the methods. FS methods were compared in terms of stability with respect to data sampling variation, similarity between selection results, and AKI prediction performance. Prediction accuracy did not intrinsically guarantee the feature ranking stability. Across different FS methods, the prediction performance did not change significantly, while the importance rankings of features were quite different. A positive correlation was observed between the complexity of suitable FS method and sample size. This study provides several practical implications, including recognizing the importance of feature stability as it is desirable for model reproducibility, identifying important AKI risk factors for further investigation, and facilitating early prediction of AKI.

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Risk of postoperative acute kidney injury in patients undergoing orthopaedic surgery--development and validation of a risk score and effect of acute kidney injury on survival: observational cohort study

Cited by 139 publications

References 42 publications

Intermediate and Long-term Outcomes of Survivors of Acute Kidney Injury Episodes: A Large Population-Based Cohort Study

Intermediate and Long-term Outcomes of Survivors of Acute Kidney Injury Episodes: A Large Population-Based Cohort Study

Sex differences in utilization and outcomes of catheter-directed thrombolysis in patients with proximal lower extremity deep venous thrombosis – Insights from the Nationwide Inpatient Sample

Feature Ranking in Predictive Models for Hospital-Acquired Acute Kidney Injury

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