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Acute kidney injury: a risk scoring system for general surgical patients

28 November 2019
Volume 28 · Issue 21


This article describes the development of a scoring system for general surgical patients to highlight those at greater risk of developing acute kidney injury (AKI). Following a search of the literature on current practice, a list of common variables was composed. Hospital Episode Statistics (HES) data from two random hospital trusts was used. With the help of a risk analysis system (CRAB Medical module, CRAB Clinical Informatics Ltd) it was possible to examine the relationship between potential risk factors and the incidence of AKI. Using Analyse-it for Excel a binary logistic model was created, which led to the development of a logistic regression equation and consequently a scoring system. The sensitivity and specificity of the model was tested using the receiver operating characteristic (ROC) curve. There was good correlation across the whole risk spectrum with an area under ROC curve of 0.806 (95% confidence intervals 0.787–0.825). The scoring system was developed into an admission checklist for general surgical patients to highlight a patient's risk of developing AKI. In a ward setting a checklist that immediately assesses the patient and produces a rapid indication as to whether the patient is at high risk or low risk would seem to be the ideal tool.

Acute kidney injury (AKI) is an acute failure of renal excretory function (Richards and Edwards, 2012). Over the years there have been many attempts to define AKI. The National Institute for Health and Care Excellence (NICE) (2013a) recommends that AKI detection should be in line with the RIFLE (risk, injury, failure, loss of kidney function, and end-stage kidney disease) definitions (Bellomo et al, 2004), Acute Kidney Injury Network (AKIN) (Mehta et al, 2007) or Kidney Disease: Improving Global Outcomes (KDIGO) (2012).

Thomas et al (2015) argued that given the multiple risk factors and causes of AKI, an ideal definition does not exist. However, Izawa et al (2016) considered that the KDIGO definition appeared to be the most appropriate definition due to its relationship with mortality and AKI stage progression. The KDIGO definition is based on either an increase in creatinine of greater than or equal to 0.3 mg/ml within 48 hours, or an increase in creatinine greater than or equal to 1.5 times baseline (which is known or presumed to have occurred within the previous 7 days), or a urine volume less than 0.5 ml/kg/hour for 6 consecutive hours (KDIGO, 2012).

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