Which Risk Predictors Are More Likely to Indicate Severe AKI in Hospitalized Patients?

Objectives: Acute kidney injury (AKI) is a sudden episode of kidney failure or damage and the risk of AKI is determined by the complex interactions of patient factors. In this study, we aimed to find out which risk factors in hospitalized patients are more likely to indicate severe AKI.

Methods: We constructed a retrospective cohort of adult patients from all inpatient units of a tertiary care academic hospital between November 2007 and December 2016. AKI predictors included demographic information, admission and discharge dates, medications, laboratory values, past medical diagnoses and admission diagnosis. We developed a machine learning-based knowledge mining model and a screening framework to analyze which risk predictors are more likely to imply severe AKI in hospitalized populations.

Results: Among the final analysis cohort of 76,957 hospital admissions, AKI occurred in 7,259 (9.43 %) with 6,396 (8.31 %) at stage 1, 678 (0.88 %) at stage 2, and 185 (0.24 %) at stage 3. We compared the non-AKI (without AKI) vs any AKI (stages 1-3), and mild AKI (stage 1) vs severe AKI (stages 2 and 3), where the best cross-validated area under the receiver operator characteristic curve (AUC) were 0.81 (95 % CI, 0.79-0.82) and 0.66 (95 % CI, 0.62-0.71), respectively. Using the developed knowledge mining model and screening framework, we identified 33 risk predictors indicating that severe AKI may occur.

Conclusions: This study screened out 33 risk predictors that are more likely to indicate severe AKI in hospitalized patients, which would help strengthen the early care and prevention of patients.