External Validation for Acute Kidney Injury Severity Scores: A Multicenter Retrospective Study in 14 Japanese ICUs

2015 ◽  
Vol 42 (1) ◽  
pp. 57-64 ◽  
Author(s):  
Tetsu Ohnuma ◽  
Shigehiko Uchino ◽  
Noriyoshi Toki ◽  
Kenta Takeda ◽  
Yoshitomo Namba ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Intensive Care ◽  
Injury Severity ◽  
Characteristic Curve ◽  
External Validation ◽  
Kidney Injury ◽  
Receiver Operator Characteristic Curve ◽  
Saps Ii ◽  
Severity Scores ◽  
Saps Ii Score

Background/Aims: Acute kidney injury (AKI) is associated with high mortality. Multiple AKI severity scores have been derived to predict patient outcome. We externally validated new AKI severity scores using the Japanese Society for Physicians and Trainees in Intensive Care (JSEPTIC) database. Methods: New AKI severity scores published in the 21st century (Mehta, Stuivenberg Hospital Acute Renal Failure (SHARF) II, Program to Improve Care in Acute Renal Disease (PICARD), Vellore and Demirjian), Liano, Simplified Acute Physiology Score (SAPS) II and lactate were compared using the JSEPTIC database that collected retrospectively 343 patients with AKI who required continuous renal replacement therapy (CRRT) in 14 intensive care units. Accuracy of the severity scores was assessed by the area under the receiver-operator characteristic curve (AUROC, discrimination) and Hosmer-Lemeshow test (H-L test, calibration). Results: The median age was 69 years and 65.8% were male. The median SAPS II score was 53 and the hospital mortality was 58.6%. The AUROC curves revealed low discrimination ability of the new AKI severity scores (Mehta 0.65, SHARF II 0.64, PICARD 0.64, Vellore 0.64, Demirjian 0.69), similar to Liano 0.67, SAPS II 0.67 and lactate 0.64. The H-L test also demonstrated that all assessed scores except for Liano had significantly low calibration ability. Conclusions: Using a multicenter database of AKI patients requiring CRRT, this study externally validated new AKI severity scores. While the Demirjian's score and Liano's score showed a better performance, further research will be required to confirm these findings.

Scoring systems in acute kidney injury patients

2015 ◽  
Author(s):  
Angel Candela-Toha ◽  
Teresa Tenorio ◽  
Aurora Lietor ◽  
Fernando Liaño
Keyword(s):  
Acute Kidney Injury ◽  
Intensive Care ◽  
Characteristic Curve ◽  
External Validation ◽  
Kidney Injury ◽  
Severity Of Illness ◽  
Scoring Systems ◽  
Early Therapy ◽  
Discrimination Ability ◽  
Improve Risk Stratification

The development of severity of illness scoring systems in the intensive care unit was prompted by the high mortality of patients in this setting. The great changes in the field of intensive care medicine have fostered new and more complex generations of scoring systems. There are several versions of the three major models used, APACHE, SAPS, and MPM. Among them, APACHE II remains the most frequently used. When these generic models are applied to acute kidney injury (AKI) patients, their discrimination ability measured by the area under the receiver operating characteristic curve is about 0.8. Another approach to prognosis of AKI patients was the development of specific scoring systems. While initial models were flawed by methodological problems, a second generation of prognosis systems for AKI patients is now available. Their discriminatory power goes beyond that of generic scores. However, some of them are awaiting external validation. Specific scoring systems for AKI patients must show their usefulness in future early-therapy trials. While we await effective therapies for AKI, the role of these systems is to improve risk stratification by the addition of new untested variables.

scholarly journals 186 Acute Kidney Injury in Skeletal Trauma Admissions to Intensive Care: An Under-Estimated Complication

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
O Brown ◽  
T Crisp ◽  
M Flatman ◽  
C Hing
Keyword(s):  
Acute Kidney Injury ◽  
Intensive Care ◽  
Injury Severity ◽  
Penetrating Trauma ◽  
Kidney Injury ◽  
Long Bone ◽  
Trauma Patients ◽  
Skeletal Trauma ◽  
Body Regions ◽  
Intensive Care Stay

Abstract Introduction Acute kidney injury (AKI) is associated with prolonged admission and 3.5 times increased mortality for trauma patients requiring intensive care (ICU) treatment. Blunt trauma confers greater risk of AKI than penetrating trauma, potentially related to long bone fracture. The relationship between skeletal trauma and AKI in ICU has not previously been investigated. Method Retrospective data was analysed from 202 consecutive adult patients admitted to ICU with skeletal trauma from 01/06/2018 to 01/06/2019. AKI was defined by creatinine rise >1.5 times baseline. Results AKI was found in 70/202 (34.65%) patients aged 16-99 years, 138 males and 64 females. Mean limb Abbreviated Injury Scale (AIS) was significantly higher in AKI (AIS= 2.57 (SD 0.53) versus non-AKI AIS=2.38 (SD 0.61), p = 0.027). Other body regions and total Injury Severity Score (ISS) were non-significant. AKI was associated with a significantly worse Glasgow Outcome Score (AKI 3.28 (SD 1.52) versus 4.02 (SD 1.08) p < 0.001), increased intensive care stay (AKI 7.03 (SD 8.30) days versus non-AKI 3.8 (SD 4.1) days p < 0.001) and increased 30-day mortality (AKI 18/70 (25.71%) versus non-AKI 10/132 (7.58%) p < 0.001) Conclusions Skeletal trauma patients have a high incidence of AKI, which was significantly correlated with severity of skeletal limb trauma but not overall ISS.

scholarly journals 2409. External Validation and Comparison of Clostridioides difficile Severity Scoring Systems

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S831-S832
Author(s):  
Donald A Perry ◽  
Daniel Shirley ◽  
Dejan Micic ◽  
Rosemary K B Putler ◽  
Pratish Patel ◽  
...  
Keyword(s):  
Binary Classification ◽  
Characteristic Curve ◽  
External Validation ◽  
Receiver Operator Characteristic Curve ◽  
Adverse Outcomes ◽  
Risk Scores ◽  
Composite Outcome ◽  
Clostridioides Difficile ◽  
Severity Scores ◽  
Primary Composite Outcome

Abstract Background Annually in the US alone, Clostridioides difficile infection (CDI) afflicts nearly 500,000 patients causing 29,000 deaths. Since early and aggressive interventions could save lives but are not optimally deployed in all patients, numerous studies have published predictive models for adverse outcomes. These models are usually developed at a single institution, and largely are not externally validated. This aim of this study was to validate the predictability for severe CDI with previously published risk scores in a multicenter cohort of patients with CDI. Methods We conducted a retrospective study on four separate inpatient cohorts with CDI from three distinct sites: the Universities of Michigan (2010–2012 and 2016), Chicago (2012), and Wisconsin (2012). The primary composite outcome was admission to an intensive care unit, colectomy, and/or death attributed to CDI within 30 days of positive test. Structured query and manual chart review abstracted data from the medical record at each site. Published CDI severity scores were assessed and compared with each other and the IDSA guideline definition of severe CDI. Sensitivity, specificity, area under the receiver operator characteristic curve (AuROC), precision-recall curves, and net reclassification index (NRI) were calculated to compare models. Results We included 3,775 patients from the four cohorts (Table 1) and evaluated eight severity scores (Table 2). The IDSA (baseline comparator) model showed poor performance across cohorts(Table 3). Of the binary classification models, including those that were most predictive of the primary composite outcome, Jardin, performed poorly with minimal to no NRI improvement compared with IDSA. The continuous score models, Toro and ATLAS, performed better, but the AuROC varied by site by up to 17% (Table 3). The Gujja model varied the most: from most predictive in the University of Michigan 2010–2012 cohort to having no predictive value in the 2016 cohort (Table 3). Conclusion No published CDI severity score showed stable, acceptable predictive ability across multiple cohorts/institutions. To maximize performance and clinical utility, future efforts should focus on a multicenter-derived and validated scoring system, and/or incorporate novel biomarkers. Disclosures All authors: No reported disclosures.

Continuous renal replacement therapy for critically ill patients in the intensive care units of two tertiary hospitals. v1

2021 ◽  
Author(s):  
Jorge not provided not provided Machado Alba
Keyword(s):  
Acute Kidney Injury ◽  
Intensive Care ◽  
Renal Replacement Therapy ◽  
Continuous Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Intensive Care Units ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Kidney Injury ◽  
Severity Scores

Introduction: Acute kidney injury is characterized by a sudden decrease in renal function. The objective was to determine the variables that are associated with the need for continuous renal replacement therapy and its outcome in critically ill patients treated in two intensive care units. Methods. A cohort follow-up study with reviewed clinical histories of 140 patients admitted between January-2012 and July-2015, who were receiving continuous therapy, and the main outcome was survival after discharge. Clinical variables, severity scores, disease prognosis, continuous renal replacement techniques and outcomes were collected. Results. Mean age was 61.9±17.6 years, and 60.7% were men. Septic shock was the main cause of acute kidney injury. In total, 79.4% of cases died in the intensive care units. The median dose of continuous renal replacement therapy was 28 ml/kg/hour (interquartile range: 35-37). The late initiation of the therapy between 25-72 hours after the diagnosis increased the probability that the patient would experience a fatal outcome (OR:6.9, 95%CI:1.5-33.0). Conclusions: Acute kidney injury secondary to sepsis is a frequent condition in critically ill patients and is associated with high mortality rates. In these cases, continuous renal replacement therapy was the main recourse for its treatment.

Prognostic Factors for Neutropenic Patients Admitted to Intensive Care.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 3900-3900
Author(s):  
Madalena Silva ◽  
Luisa Checa ◽  
Fatima Costa ◽  
Rui Moreno ◽  
Eduardo G. Silva ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Intensive Care ◽  
Underlying Disease ◽  
Simplified Acute Physiology Score ◽  
Prognostic Impact ◽  
Saps Ii ◽  
Severity Scores ◽  
Saps Ii Score ◽  
Organ Failures ◽  
Neutropenic Patients

Abstract The admission of neutropenic patients (pts) to intensive care units (ICU) is controversial, especially when mechanical ventilation is required. Knowledge of the relative prognostic impact of factors related to the underlying disease and to the severity of acute organ failures might help avoiding futile admissions. We retrospectively assessed predictors of 30-day mortality in neutropenic (<1000/ul) pts referred from a single Hematology unit to the 2 ICUs of the institution over a 10-year period. Of 66 consecutive pts, median age 48 (15–73), 82% had acute leukemia (AL) and 21% were in complete remission (CR). On ICU admission 62% of the pts had a neutrophil count ≤500/ul; microbiologically documented infection was found in 42%. The main reason for ICU referral was severe sepsis or septic shock in 62% of the cases and respiratory failure in 38%. Seventy per cent of the pts were already on vasopressor agents. At ICU entry the median Simplified Acute Physiology Score (SAPS) II was 63 and 26% of pts had ≥ 2 acute organ system failures (OSF). Coma was present in 23%. Mechanical ventilation was eventually needed in 89% and dialysis in 9% of the pts. Mortality at 30 days was 73%. By univariate logistic regression analysis mortality was not significantly related to age, to status of underlying disease (CR vs no CR/not yet known) to duration of neutropenia nor to depth of neutropenia at entry (≤ 500 vs >500/ul). Pts who died were more likely to have non-M3 AL subtype vs M3 (p=0.037), to have ≥ 2 acute OSF vs < 2 (p=0.012) and a higher SAPS II score (p< 0.001). In multivariate analysis only the latter 2 variables remained significant. In conclusion, our data show that 27% of neutropenic pts admitted to ICUs are alive at 30 days; that selection for admission should not be based on the characteristics of the underlying malignancy; and that the 30-day mortality is highly predictable by initial acute illness severity scores.

External Validation and Comparison of Clostridioides difficile Severity Scoring Systems

2021 ◽  
Author(s):  
D Alexander Perry ◽  
Daniel Shirley ◽  
Dejan Micic ◽  
C Pratish Patel ◽  
Rosemary Putler ◽  
...  
Keyword(s):  
Characteristic Curve ◽  
External Validation ◽  
Predictive Ability ◽  
Scoring Systems ◽  
Receiver Operator Characteristic Curve ◽  
Adverse Outcomes ◽  
Risk Scores ◽  
Clostridioides Difficile ◽  
Multicenter Cohort ◽  
Severity Scores

Abstract Background Many models have been developed to predict severe outcomes from Clostridioides difficile infection. These models are usually developed at a single institution and largely are not externally validated. This aim of this study was to validate previously published risk scores in a multicenter cohort of patients with CDI. Methods Retrospective study on four separate inpatient cohorts with CDI from three distinct sites: The Universities of Michigan (2010-2012 and 2016), Chicago (2012), and Wisconsin (2012). The primary composite outcome was admission to an intensive care unit, colectomy, and/or death attributed to CDI within 30 days of positive testing. Both within each cohort and combined across all cohorts, published CDI severity scores were assessed and compared to each other and the IDSA guideline definitions of severe and fulminant CDI. Results A total of 3,646 patients were included for analysis. Including the two IDSA guideline definitions, fourteen scores were assessed. Performance of scores varied within each cohort and in the combined set (mean area under the receiver operator characteristic curve(AUC 0.61, range 0.53-0.66). Only half of the scores had performance at or better than IDSA severe and fulminant definitions (AUCs 0.64 and 0.63, respectively). Most of the scoring systems had more false than true positives in the combined set (mean: 81.5%, range:0-91.5%). Conclusions No published CDI severity score showed stable, good predictive ability for adverse outcomes across multiple cohorts/institutions or in a combined multicenter cohort.

MO418CONTINUOUS RENAL REPLACEMENT THERAPY WITH REGIONAL CITRATE ANTICOAGULATION VERSUS NON-ANTICOAGULATION REGIME IN CRITICALLY ILL PATIENTS WITH ACUTE KIDNEY INJURY AND A HIGH RISK OF BLEEDING

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Violeta Knezevic ◽  
Tijana Azasevac ◽  
Gordana Strazmester Majstorovic ◽  
Mira Markovic ◽  
Igor Mitic
Keyword(s):  
Acute Kidney Injury ◽  
High Risk ◽  
Kidney Injury ◽  
Regional Citrate Anticoagulation ◽  
Mean Values ◽  
Citrate Anticoagulation ◽  
Risk Of Bleeding ◽  
Saps Ii ◽  
Saps Ii Score ◽  
Significant Difference

Abstract Background and Aims Critically ill patients with acute renal impairment (AKI) with a high risk of bleeding require treatment with one of the methods of continuous renal replacement (CRRT) with regional citrate anticoagulation (RCA) or without anticoagulation (NA). The aim of the study was to compare CRRT with RCA using calcium with CRRT in NA regimen. Method A clinical trial included 55 surgical and non-surgical patients with acute kidney injury and an episode of acute kidney injury in chronic kidney disease who were admitted to the Intensive Care Unit (ICU) during 2020. The patients were divided into two groups, RCA- CRRT with 39 and NA-CRRT with 16 patients. Demographic, clinical and lab data before and after CRRT, treatment parameters CRRT and outcomes were analyzed. Results RCA vs NA group did not differ significantly by gender (small, 71.79% vs 56.25%, p = 0.106) and age (56.53 ± 17.55 vs 45.75 ± 13.3, p = 0.220). The NA group had a significantly higher prevalence of liver disease as a reason for the ICU admission when compared to the other group (12.5% vs 0.00%, p = 0.024). The RCA group before CRRT had significantly higher mean values of CRP (173.68 ± 122.06 vs 86.33 ± 51.05, p = 0.01) and significantly lower mean values of total bilirubin (16.78 ± 4.31 vs 40.02 ± 9.22, p = 0.005) and creatinine (463.97 ± 36.24 vs 486.0 ± 36.25, p = 0.001), while after CRRT it had significantly higher average values of total calcium (2.12 ± 0.016 vs 2.11 ± 0.017, p = 0.023) and lower average values of pH (7.29 ± 0.02 vs 7.32 ± 0.015, p = 0.040) and creatinine (463.97 ± 36.24 vs 486.0 ± 36.25, p = 0.001) in relation to the NA group. No significant difference was found in relation to invasive mechanical ventilation, vasopressors therapy, SAPS II score, oliguria / anuria, recovery of renal function, the length of hospital stay and mortality (p> 0.05) (Table 1). Compared to treatment parameters, the RCA group had a significantly lower number of procedures (4.33 ± 2.80 vs 5.81 ± 1.28, p = 0.027) and ultrafiltration rate (2.79 ± 0.19 vs 3.14 ± 0.33, p = 0.015) and significantly longer hemofilter lifespan compared to NA group (24.64 ± 0.48 vs 18.10 ± 0.58, p = 0.000). Although the prevalence of bleeding was higher in the NA group, no significant difference was found between the groups (37.5% vs 28.20%, p = 0.498), as well as in the infusion of red blood cell (33.3% vs 37.5%, p = 0.768), fresh frozen plasma (28.2% vs 50%, p = 0.742) and platelets (35.89 vs 31.25, p = 0.123). The overall citrate accumulation (CA> 2.25) rate was 5.12% in the RCA group (Table 2). The Kaplan-Meier survival analysis using the log-rank test (Mantel-Cox test) for comparing the hemofilter lifespan between RCA and NA regime found a significant difference in survival between the groups (χ2 = 3,789, p = 0,049) (Figure 1). Multiple regression model for testing risk factors SAPS II score, Oxiris membrane, UF, lactate, hemoglobin concentration, platelet count, Activated Partial Thromboplastin Time and Prothrombin Time on hemofilter survival has shown a significant linear relationship without statistical significance in both RCA groups (R=0.544 ; F=1.575) and NA (R=0.757; F=1.171) (Table 3). Conclusion RCA-CRRT did not show a significant difference in the prevalence of bleeding compared to NA-CRRT in the patients with a high risk of bleeding, but the survival rate of hemofilters was significantly longer in RCA-CRRT, which suggested the need for further research.

scholarly journals Development and External Validation of Deep-Learning-Based Tumor Grading Models in Soft-Tissue Sarcoma Patients Using MR Imaging

Cancers ◽  
2021 ◽  
Vol 13 (12) ◽  
pp. 2866
Author(s):  
Fernando Navarro ◽  
Hendrik Dapper ◽  
Rebecca Asadpour ◽  
Carolin Knebel ◽  
Matthew B. Spraker ◽  
...  
Keyword(s):  
Deep Learning ◽  
Soft Tissue ◽  
Mr Imaging ◽  
Characteristic Curve ◽  
External Validation ◽  
Soft Tissue Sarcomas ◽  
Treatment Decision ◽  
Receiver Operator Characteristic Curve ◽  
Low Grade ◽  
Tumor Grading

Background: In patients with soft-tissue sarcomas, tumor grading constitutes a decisive factor to determine the best treatment decision. Tumor grading is obtained by pathological work-up after focal biopsies. Deep learning (DL)-based imaging analysis may pose an alternative way to characterize STS tissue. In this work, we sought to non-invasively differentiate tumor grading into low-grade (G1) and high-grade (G2/G3) STS using DL techniques based on MR-imaging. Methods: Contrast-enhanced T1-weighted fat-saturated (T1FSGd) MRI sequences and fat-saturated T2-weighted (T2FS) sequences were collected from two independent retrospective cohorts (training: 148 patients, testing: 158 patients). Tumor grading was determined following the French Federation of Cancer Centers Sarcoma Group in pre-therapeutic biopsies. DL models were developed using transfer learning based on the DenseNet 161 architecture. Results: The T1FSGd and T2FS-based DL models achieved area under the receiver operator characteristic curve (AUC) values of 0.75 and 0.76 on the test cohort, respectively. T1FSGd achieved the best F1-score of all models (0.90). The T2FS-based DL model was able to significantly risk-stratify for overall survival. Attention maps revealed relevant features within the tumor volume and in border regions. Conclusions: MRI-based DL models are capable of predicting tumor grading with good reproducibility in external validation.

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