Acute kidney injury and its progression in hospitalized patients-Results from a retrospective multicentre cohort study with a digital decision support system.
In this retrospective multicentric cohort study, we evaluate the potential benefits of a clinical decision support system (CDSS) for the automated detection of Acute kidney injury (AKI). A total of 80,389 cases, hospitalized from 2017 to 2019 at a tertiary care hospital (University of Leipzig Medica...
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Public Library of Science (PLoS)
2021-01-01
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| Series: | PLoS ONE |
| Online Access: | https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0254608&type=printable |
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| author | Thea Sophie Kister Johannes Remmler Maria Schmidt Martin Federbusch Felix Eckelt Berend Isermann Heike Richter Markus Wehner Uwe Krause Jan Halbritter Carina Cundius Markus Voigt Alexander Kehrer Jörg Michael Telle Thorsten Kaiser |
| author_facet | Thea Sophie Kister Johannes Remmler Maria Schmidt Martin Federbusch Felix Eckelt Berend Isermann Heike Richter Markus Wehner Uwe Krause Jan Halbritter Carina Cundius Markus Voigt Alexander Kehrer Jörg Michael Telle Thorsten Kaiser |
| author_sort | Thea Sophie Kister |
| collection | DOAJ |
| description | In this retrospective multicentric cohort study, we evaluate the potential benefits of a clinical decision support system (CDSS) for the automated detection of Acute kidney injury (AKI). A total of 80,389 cases, hospitalized from 2017 to 2019 at a tertiary care hospital (University of Leipzig Medical Center (ULMC)) and two primary care hospitals (Muldentalkliniken (MTL)) in Germany, were enrolled. AKI was defined and staged according to the Kidney disease: improving global outcomes (KDIGO) guidelines. Clinical and laboratory data was automatically collected from electronic patient records using the frameworks of the CDSS. In our cohort, we found an overall AKI incidence proportion of 12.1%. We identified 6,393/1,703/1,604 cases as AKI stage 1/2/3 (8.0%/2.1%/2.0%, respectively). Administrative coding with N17 (ICD-10-GM) was missing in 55.8% of all AKI cases with the potential for additional diagnosis related groups (DRG) reimbursement of 1,204,200 € in our study. AKI was associated with higher hospital mortality, increased length of hospitalisation and more frequent need of renal replacement therapy. A total of 19.1% of AKI cases (n = 1,848) showed progression to higher AKI stages (progressive AKI) during hospitalization. These cases presented with considerably longer hospitalization, higher rates of renal replacement therapy and increased mortality (p<0.001, respectively). Furthermore, progressive AKI was significantly associated with sepsis, shock, liver cirrhosis, myocardial infarction, and cardiac insufficiency. AKI, and especially its progression during hospitalization, is strongly associated with adverse outcomes. Our automated CDSS enables timely detection and bears potential to improve AKI outcomes, notably in cases of progressive AKI. |
| format | Article |
| id | doaj-art-e59bf6e3d69b4da497b44532fb42c6c7 |
| institution | OA Journals |
| issn | 1932-6203 |
| language | English |
| publishDate | 2021-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj-art-e59bf6e3d69b4da497b44532fb42c6c72025-08-20T02:00:56ZengPublic Library of Science (PLoS)PLoS ONE1932-62032021-01-01167e025460810.1371/journal.pone.0254608Acute kidney injury and its progression in hospitalized patients-Results from a retrospective multicentre cohort study with a digital decision support system.Thea Sophie KisterJohannes RemmlerMaria SchmidtMartin FederbuschFelix EckeltBerend IsermannHeike RichterMarkus WehnerUwe KrauseJan HalbritterCarina CundiusMarkus VoigtAlexander KehrerJörg Michael TelleThorsten KaiserIn this retrospective multicentric cohort study, we evaluate the potential benefits of a clinical decision support system (CDSS) for the automated detection of Acute kidney injury (AKI). A total of 80,389 cases, hospitalized from 2017 to 2019 at a tertiary care hospital (University of Leipzig Medical Center (ULMC)) and two primary care hospitals (Muldentalkliniken (MTL)) in Germany, were enrolled. AKI was defined and staged according to the Kidney disease: improving global outcomes (KDIGO) guidelines. Clinical and laboratory data was automatically collected from electronic patient records using the frameworks of the CDSS. In our cohort, we found an overall AKI incidence proportion of 12.1%. We identified 6,393/1,703/1,604 cases as AKI stage 1/2/3 (8.0%/2.1%/2.0%, respectively). Administrative coding with N17 (ICD-10-GM) was missing in 55.8% of all AKI cases with the potential for additional diagnosis related groups (DRG) reimbursement of 1,204,200 € in our study. AKI was associated with higher hospital mortality, increased length of hospitalisation and more frequent need of renal replacement therapy. A total of 19.1% of AKI cases (n = 1,848) showed progression to higher AKI stages (progressive AKI) during hospitalization. These cases presented with considerably longer hospitalization, higher rates of renal replacement therapy and increased mortality (p<0.001, respectively). Furthermore, progressive AKI was significantly associated with sepsis, shock, liver cirrhosis, myocardial infarction, and cardiac insufficiency. AKI, and especially its progression during hospitalization, is strongly associated with adverse outcomes. Our automated CDSS enables timely detection and bears potential to improve AKI outcomes, notably in cases of progressive AKI.https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0254608&type=printable |
| spellingShingle | Thea Sophie Kister Johannes Remmler Maria Schmidt Martin Federbusch Felix Eckelt Berend Isermann Heike Richter Markus Wehner Uwe Krause Jan Halbritter Carina Cundius Markus Voigt Alexander Kehrer Jörg Michael Telle Thorsten Kaiser Acute kidney injury and its progression in hospitalized patients-Results from a retrospective multicentre cohort study with a digital decision support system. PLoS ONE |
| title | Acute kidney injury and its progression in hospitalized patients-Results from a retrospective multicentre cohort study with a digital decision support system. |
| title_full | Acute kidney injury and its progression in hospitalized patients-Results from a retrospective multicentre cohort study with a digital decision support system. |
| title_fullStr | Acute kidney injury and its progression in hospitalized patients-Results from a retrospective multicentre cohort study with a digital decision support system. |
| title_full_unstemmed | Acute kidney injury and its progression in hospitalized patients-Results from a retrospective multicentre cohort study with a digital decision support system. |
| title_short | Acute kidney injury and its progression in hospitalized patients-Results from a retrospective multicentre cohort study with a digital decision support system. |
| title_sort | acute kidney injury and its progression in hospitalized patients results from a retrospective multicentre cohort study with a digital decision support system |
| url | https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0254608&type=printable |
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