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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Autores principales:	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
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/e59bf6e3d69b4da497b44532fb42c6c7
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spelling	oai:doaj.org-article:e59bf6e3d69b4da497b44532fb42c6c72021-12-02T20:15:27ZAcute kidney injury and its progression in hospitalized patients-Results from a retrospective multicentre cohort study with a digital decision support system.1932-620310.1371/journal.pone.0254608https://doaj.org/article/e59bf6e3d69b4da497b44532fb42c6c72021-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0254608https://doaj.org/toc/1932-6203In 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.Thea Sophie KisterJohannes RemmlerMaria SchmidtMartin FederbuschFelix EckeltBerend IsermannHeike RichterMarkus WehnerUwe KrauseJan HalbritterCarina CundiusMarkus VoigtAlexander KehrerJörg Michael TelleThorsten KaiserPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 7, p e0254608 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q 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.
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
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
title	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_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_sort	acute kidney injury and its progression in hospitalized patients-results from a retrospective multicentre cohort study with a digital decision support system.
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/e59bf6e3d69b4da497b44532fb42c6c7
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Acute kidney injury and its progression in hospitalized patients-Results from a retrospective multicentre cohort study with a digital decision support system.

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