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Title: Assessment of acute kidney injury risk using a machine-learning guided generalized structural equation model: a cohort study
Authors: Wong, Wen En Joseph
Chan, Siew Pang 
Yong, Juin Keith
Tham, Yen Yu Sherlyn
Lim, Jie Rui Gerald
Sim, Ming Ann
Soh, Chai Rick
Ti, Lian Kah 
Chew, Tsong Huey Sophia 
Keywords: Acute kidney injury
Critically ill
Issue Date: 22-Feb-2021
Publisher: BioMed Central Ltd
Citation: Wong, Wen En Joseph, Chan, Siew Pang, Yong, Juin Keith, Tham, Yen Yu Sherlyn, Lim, Jie Rui Gerald, Sim, Ming Ann, Soh, Chai Rick, Ti, Lian Kah, Chew, Tsong Huey Sophia (2021-02-22). Assessment of acute kidney injury risk using a machine-learning guided generalized structural equation model: a cohort study. BMC Nephrology 22 (1) : 63. ScholarBank@NUS Repository.
Rights: Attribution 4.0 International
Abstract: Background: Acute kidney injury is common in the surgical intensive care unit (ICU). It is associated with poor patient outcomes and high healthcare resource usage. This study’s primary objective is to help identify which ICU patients are at high risk for acute kidney injury. Its secondary objective is to examine the effect of acute kidney injury on a patient’s prognosis during and after the ICU admission. Methods: A retrospective cohort of patients admitted to a Singaporean surgical ICU between 2015 to 2017 was collated. Patients undergoing chronic dialysis were excluded. The outcomes were occurrence of ICU acute kidney injury, hospital mortality and one-year mortality. Predictors were identified using decision tree algorithms. Confirmatory analysis was performed using a generalized structural equation model. Results: A total of 201/940 (21.4%) patients suffered acute kidney injury in the ICU. Low ICU haemoglobin levels, low ICU bicarbonate levels, ICU sepsis, low pre-ICU estimated glomerular filtration rate (eGFR) and congestive heart failure was associated with the occurrence of ICU acute kidney injury. Acute kidney injury, together with old age (> 70 years), and low pre-ICU eGFR, was associated with hospital mortality, and one-year mortality. ICU haemoglobin level was discretized into 3 risk categories for acute kidney injury: high risk (haemoglobin ?9.7 g/dL), moderate risk (haemoglobin between 9.8–12 g/dL), and low risk (haemoglobin > 12 g/dL). Conclusion: The occurrence of acute kidney injury is common in the surgical ICU. It is associated with a higher risk for hospital and one-year mortality. These results, in particular the identified haemoglobin thresholds, are relevant for stratifying a patient’s acute kidney injury risk. © 2021, The Author(s).
Source Title: BMC Nephrology
ISSN: 1471-2369
DOI: 10.1186/s12882-021-02238-9
Rights: Attribution 4.0 International
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