title: The initial development and assessment of an automatic alert warning of acute kidney injury.
abstract: BACKGROUND
  Acute kidney injury (AKI) recognition by clinicians has been shown to be suboptimal. Little work has focused on the use of an automated warning of a rise in a patient's creatinine, indicating AKI.
  
  
  METHODS
  Over 3 months in 2008 we ran a prospective observational study of 'alerts' sent by our Integrated Clinical Environment pathology system, identifying all patients with a ≥ 75% rise in their creatinine from its previous value. Information was collected on subsequent renal function, comorbidities and other potential predictors of survival.
  
  
  RESULTS
  In the 3-month period 463 adults with a first episode of AKI were identified by an alert; 87% were hospital inpatients. Median follow-up was 404 days. In-hospital mortality was 36% for those who were admitted. After performing Weibull survival analysis, significant predictors of poorer survival were the presence of metastatic, haematological or lower risk malignancy, a residential or nursing home address and higher age, number of non-malignant comorbidities or C-reactive protein level. Predictors of better survival were higher serum albumin level or nadir GFR during the episode and Indian subcontinent ethnicity. A receiver-operator curve for a prognostic score developed from the analysis showed an area under the curve of 0.84.
  
  
  CONCLUSIONS
  The alerts identified a group of AKI patients who are at moderately high risk of death. The prognostic score using a combination of covariates shows early promise. Both the alerts and the score warrant further development as tools for earlier intervention in AKI.
authors.affiliation: 1Department of Renal Medicine, Birmingham Heartlands Hospital, Bordesley Green East B9 5SS, UK. mark.thomas@heartofengland.nhs.uk
authors.forename: Mark
authors.initials: M
authors.lastname: Thomas
authors.forename: Alice
authors.initials: A
authors.lastname: Sitch
authors.forename: George
authors.initials: G
authors.lastname: Dowswell
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis* / Q000401:mortality / Q000517:prevention & control*; D000293:Adolescent; D000328:Adult; D000368:Aged; D001331:Automation; D002097:C-Reactive Protein / Q000378:metabolism; D003404:Creatinine / Q000097:blood*; D005260:Female; D005919:Glomerular Filtration Rate; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012720:Severity of Illness Index; D015996:Survival Rate; D013997:Time Factors; D055815:Young Adult
chemical_list: D002097:C-Reactive Protein; D003404:Creatinine