title: Approaches to Predicting Outcomes in Patients with Acute Kidney Injury.
abstract: Despite recognition that Acute Kidney Injury (AKI) leads to substantial increases in morbidity, mortality, and length of stay, accurate prognostication of these clinical events remains difficult. It remains unclear which approaches to variable selection and model building are most robust. We used data from a randomized trial of AKI alerting to develop time-updated prognostic models using stepwise regression compared to more advanced variable selection techniques. We randomly split data into training and validation cohorts. Outcomes of interest were death within 7 days, dialysis within 7 days, and length of stay. Data elements eligible for model-building included lab values, medications and dosages, procedures, and demographics. We assessed model discrimination using the area under the receiver operator characteristic curve and r-squared values. 2241 individuals were available for analysis. Both modeling techniques created viable models with very good discrimination ability, with AUCs exceeding 0.85 for dialysis and 0.8 for death prediction. Model performance was similar across model building strategies, though the strategy employing more advanced variable selection was more parsimonious. Very good to excellent prediction of outcome events is feasible in patients with AKI. More advanced techniques may lead to more parsimonious models, which may facilitate adoption in other settings.
authors.affiliation: Yale University School of Medicine, New Haven, CT, United States of America.
authors.forename: Danielle
authors.initials: D
authors.lastname: Saly
authors.affiliation: Yale University School of Medicine, New Haven, CT, United States of America.
authors.forename: Alina
authors.initials: A
authors.lastname: Yang
authors.affiliation: Yale University School of Public Health, New Haven, CT, United States of America.
authors.forename: Corey
authors.initials: C
authors.lastname: Triebwasser
authors.affiliation: Yale University School of Public Health, New Haven, CT, United States of America.
authors.forename: Janice
authors.initials: J
authors.lastname: Oh
authors.affiliation: Yale University School of Medicine, New Haven, CT, United States of America.
authors.forename: Qisi
authors.initials: Q
authors.lastname: Sun
authors.affiliation: Yale University School of Medicine, New Haven, CT, United States of America.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Testani
authors.affiliation: Yale University School of Medicine, New Haven, CT, United States of America.|Program of Applied Translational Research, Yale University School of Medicine, New Haven, CT, United States of America.|Clinical Epidemiology Research Center, Veterans Affairs Medical Center, West Haven, CT, United States of America.
authors.forename: Chirag R
authors.initials: CR
authors.lastname: Parikh
authors.affiliation: Program of Applied Translational Research, Yale University School of Medicine, New Haven, CT, United States of America.
authors.forename: Joshua
authors.initials: J
authors.lastname: Bia
authors.affiliation: Program of Applied Translational Research, Yale University School of Medicine, New Haven, CT, United States of America.
authors.forename: Aditya
authors.initials: A
authors.lastname: Biswas
authors.affiliation: Helynx, Inc, Altadena, CA, United States of America.
authors.forename: Chess
authors.initials: C
authors.lastname: Stetson
authors.affiliation: Helynx, Inc, Altadena, CA, United States of America.
authors.forename: Kris
authors.initials: K
authors.lastname: Chaisanguanthum
authors.affiliation: Yale University School of Medicine, New Haven, CT, United States of America.|Program of Applied Translational Research, Yale University School of Medicine, New Haven, CT, United States of America.|Clinical Epidemiology Research Center, Veterans Affairs Medical Center, West Haven, CT, United States of America.
authors.forename: F Perry
authors.identifier: http://orcid.org/0000-0002-2633-2412
authors.initials: FP
authors.lastname: Wilson
mesh_terms: D058186:Acute Kidney Injury / Q000401:mortality* / Q000628:therapy; D000368:Aged; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D011237:Predictive Value of Tests; D011379:Prognosis; D006435:Renal Dialysis; D018570:Risk Assessment; D013997:Time Factors