title: AKIpredictor, an online prognostic calculator for acute kidney injury in adult critically ill patients: development, validation and comparison to serum neutrophil gelatinase-associated lipocalin.
abstract: OBJECTIVE
  Early diagnosis of acute kidney injury (AKI) remains a major challenge. We developed and validated AKI prediction models in adult ICU patients and made these models available via an online prognostic calculator. We compared predictive performance against serum neutrophil gelatinase-associated lipocalin (NGAL) levels at ICU admission.
  
  
  METHODS
  Analysis of the large multicenter EPaNIC database. Model development (n = 2123) and validation (n = 2367) were based on clinical information available (1) before and (2) upon ICU admission, (3) after 1 day in ICU and (4) including additional monitoring data from the first 24 h. The primary outcome was a comparison of the predictive performance between models and NGAL for the development of any AKI (AKI-123) and AKI stages 2 or 3 (AKI-23) during the first week of ICU stay.
  
  
  RESULTS
  Validation cohort prevalence was 29% for AKI-123 and 15% for AKI-23. The AKI-123 model before ICU admission included age, baseline serum creatinine, diabetes and type of admission (medical/surgical, emergency/planned) and had an AUC of 0.75 (95% CI 0.75-0.75). The AKI-23 model additionally included height and weight (AUC 0.77 (95% CI 0.77-0.77)). Performance consistently improved with progressive data availability to AUCs of 0.82 (95% CI 0.82-0.82) for AKI-123 and 0.84 (95% CI 0.83-0.84) for AKI-23 after 24 h. NGAL was less discriminant with AUCs of 0.74 (95% CI 0.74-0.74) for AKI-123 and 0.79 (95% CI 0.79-0.79) for AKI-23.
  
  
  CONCLUSIONS
  AKI can be predicted early with models that only use routinely collected clinical information and outperform NGAL measured at ICU admission. The AKI-123 models are available at http://akipredictor.com/ . Trial registration Clinical Trials.gov NCT00512122.
authors.affiliation: Clinical Division and Laboratory of Intensive Care Medicine, Academic Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Herestraat 49, B-3000, Leuven, Belgium.
authors.forename: Marine
authors.initials: M
authors.lastname: Flechet
authors.affiliation: Clinical Division and Laboratory of Intensive Care Medicine, Academic Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Herestraat 49, B-3000, Leuven, Belgium. fabian.guiza@kuleuven.be.
authors.forename: Fabian
authors.initials: F
authors.lastname: Güiza
authors.affiliation: Clinical Division and Laboratory of Intensive Care Medicine, Academic Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Herestraat 49, B-3000, Leuven, Belgium.
authors.forename: Miet
authors.initials: M
authors.lastname: Schetz
authors.affiliation: Clinical Division and Laboratory of Intensive Care Medicine, Academic Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Herestraat 49, B-3000, Leuven, Belgium.
authors.forename: Pieter
authors.initials: P
authors.lastname: Wouters
authors.affiliation: Clinical Division and Laboratory of Intensive Care Medicine, Academic Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Herestraat 49, B-3000, Leuven, Belgium.
authors.forename: Ilse
authors.initials: I
authors.lastname: Vanhorebeek
authors.affiliation: Clinical Division and Laboratory of Intensive Care Medicine, Academic Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Herestraat 49, B-3000, Leuven, Belgium.
authors.forename: Inge
authors.initials: I
authors.lastname: Derese
authors.affiliation: Clinical Division and Laboratory of Intensive Care Medicine, Academic Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Herestraat 49, B-3000, Leuven, Belgium.
authors.forename: Jan
authors.initials: J
authors.lastname: Gunst
authors.affiliation: Pharmacy Department, Department of Pharmaceutical and Pharmacological Sciences, University Hospitals Leuven and Clinical Pharmacology and Pharmacotherapy, KU Leuven, Leuven, Belgium.
authors.forename: Isabel
authors.initials: I
authors.lastname: Spriet
authors.affiliation: Clinical Division and Laboratory of Intensive Care Medicine, Academic Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Herestraat 49, B-3000, Leuven, Belgium.
authors.forename: Michaël
authors.initials: M
authors.lastname: Casaer
authors.affiliation: Clinical Division and Laboratory of Intensive Care Medicine, Academic Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Herestraat 49, B-3000, Leuven, Belgium.
authors.forename: Greet
authors.initials: G
authors.lastname: Van den Berghe
authors.affiliation: Clinical Division and Laboratory of Intensive Care Medicine, Academic Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Herestraat 49, B-3000, Leuven, Belgium.
authors.forename: Geert
authors.initials: G
authors.lastname: Meyfroidt
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood*; D015331:Cohort Studies; D003422:Critical Care / Q000379:methods*; D016638:Critical Illness / Q000628:therapy*; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D020407:Internet; D000071068:Lipocalin-2 / Q000097:blood*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis
chemical_list: D015415:Biomarkers; D000071068:Lipocalin-2
keywords: Acute kidney injury; Early detection; NGAL; Prediction model