title: Improving outcomes in patients with Acute Kidney Injury: the impact of hospital based automated AKI alerts.
abstract: BACKGROUND
  Acute kidney injury (AKI) is a significant cause of morbidity and mortality. Early identification may improve the outcome and in 2012 our hospital introduced an automated AKI alert system for early detection and management of AKI.
  
  
  OBJECTIVE
  Using an automated AKI alert system we analysed whether early review and intervention by the Critical Care and Outreach (CCOT) team improved patient outcomes in AKI and whether serum bicarbonate was useful in predicting outcomes in patients with AKI.
  
  
  METHODS
  In a retrospective analysis we identified patients who triggered an AKI alert from 20 April 2012 to 20 September 2013 and collected data on mortality, length of stay, need for intensive care admission and renal replacement therapy (RRT).
  
  
  RESULTS
  994 AKI alerts were generated and analysed. Patients with bicarbonate outside the normal range had significantly higher mortality. Bicarbonate <22 mmol/L was associated with a mortality of 25.7% (49/191) compared with 16.9% (39/231) when 22-29 mmol/L (p=0.047, χ(2)). Those patients reviewed ≥1 day after AKI alert by CCOT compared with those seen on the day of the alert had a 2.4 times increase in mortality and were 7 times more likely to require RRT acutely.
  
  
  CONCLUSIONS
  Electronically identified AKI alerts identify patients at high risk of morbidity and mortality. In this group AKI alerts preceded CCOT review by a mean of 2 days. This represents a window for supportive interventions, which may explain improved outcomes in those reviewed earlier. The addition of serum bicarbonate offers a further method of risk stratifying patients at greater risk of death.
authors.affiliation: Department of Nephrology, Whittington Hospital, London, UK.
authors.forename: M
authors.initials: M
authors.lastname: Prendecki
authors.affiliation: Department of Intensive Care, Whittington Hospital, London, UK.
authors.forename: E
authors.initials: E
authors.lastname: Blacker
authors.affiliation: Department of Nephrology, Whittington Hospital, London, UK.
authors.forename: O
authors.initials: O
authors.lastname: Sadeghi-Alavijeh
authors.affiliation: Department of Biochemistry, Whittington Hospital, London, UK.
authors.forename: R
authors.initials: R
authors.lastname: Edwards
authors.affiliation: Department of Intensive Care, Whittington Hospital, London, UK.
authors.forename: H
authors.initials: H
authors.lastname: Montgomery
authors.affiliation: Department of Intensive Care, Whittington Hospital, London, UK.
authors.forename: S
authors.initials: S
authors.lastname: Gillis
authors.affiliation: UCL Centre for Nephrology, Royal Free Hospital, London, UK.
authors.forename: M
authors.initials: M
authors.lastname: Harber
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood* / Q000175:diagnosis / Q000401:mortality; D000328:Adult; D000368:Aged; D000465:Algorithms; D001639:Bicarbonates / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D056902:Clinical Alarms; D003199:Computer Systems; D042241:Early Diagnosis; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D011379:Prognosis; D017582:Renal Replacement Therapy / Q000401:mortality / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D001639:Bicarbonates; D015415:Biomarkers