Artificial Intelligence for the Prediction of Acute Kidney Injury During the Perioperative Period: Systematic Review and Meta-Analysis of Diagnostic Test Accuracy

Abstract Background: Acute kidney injury (AKI) is independently associated with morbidity and mortality in a wide range of surgical settings. Nowadays, with the increasing use of electronic health records (EHR), advances in patient information retrieval, and cost reduction in clinical informatics, artificial intelligence is increasingly being used to improve early recognition and management for perioperative AKI. However, there is no quantitative synthesis of the performance of these methods.Objective: To estimate the sensitivity and specificity of artificial intelligence for the prediction of acute kidney injury during the perioperative period.Methods: Pubmed, Embase, and Cochrane Library were searched to 2nd October 2021. Studies presenting diagnostic performance of artificial intelligence in the early detection of perioperative acute kidney injury were included. Two independent evaluators extracted data. The risk of bias of eligible studies was assessed using the PROBAST tool.Results: Nineteen studies involving 304,076 patients were included. Quantitative random-effects meta-analysis using the Rutter and Gatsonis hierarchical summary receiver operating characteristics (HSROC) model revealed pooled sensitivity, specificity, and diagnostic odds ratio of 0.77 (95% CI: 0.73 to 0.81),0.75 (95% CI: 0.71 to 0.80), and 10.7 (95% CI 8.5 to 13.5), respectively. Threshold effect was found to be the only source of heterogeneity, and there was no evidence of publication bias.Conclusions: Our review demonstrates the promising performance of artificial intelligence for early prediction of perioperative AKI. Further studies should focus on the improvement of existing models, novel biomarkers, and clinical effectiveness.

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Rates, predictors and mortality of sepsis-induced acute kidney injury: systematic review and meta-analysis

10.21203/rs.3.rs-18145/v4 ◽

2020 ◽

Author(s):

Jie feng Liu ◽

Hebin Xie ◽

ziwei ye ◽

Fen Li ◽

Lesan Wang

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Septic Shock ◽

Acute Kidney Injury ◽

Meta Analysis ◽

Kidney Injury ◽

Predisposing Factors ◽

Cochrane Library ◽

Patient Specific ◽

Wide Range

Abstract Background: Due to the high incidence and mortality of sepsis-associated acute kidney injury, a significant number of studies have explored the causes of sepsis-associated acute kidney injury (AKI). However, the opinions on relevant predictive risk factors remain inconclusive. This study aimed to provide a systematic review and a meta-analysis to determine the predisposing factors for sepsis-associated AKI.Method: A systematic literature search was performed in the Medline, Embase, Cochrane Library, PubMed, and Web of Science, databases, with an end-date of 25th May 2019. Valid data were retrieved in compliance with specific inclusion and exclusion criteria.Result: Forty-seven observational studies were included for analysis, achieving a cumulative patient number of 55,911. The highest incidence of AKI was caused by septic shock. Thirty-one potential risk factors were included in the meta-analysis. Analysis showed that 20 factors were statistically significant. The odds ratio (OR) and 95% confidence interval (CI), as well as the prevalence of the most frequently-seen predisposing factors for sepsis-associated AKI, were as follows: septic shock [2.88 (2.36-3.52), 60.47%], hypertension [1.43 (1.20-1.70), 38.39%], diabetes mellitus [1.59 (1.47-1.71), 27.57%], abdominal infection [1.44 (1.32-1.58), 30.87%], the administration of vasopressors [2.95 (1.67-5.22), 64.61%], the administration of vasoactive drugs [3.85 (1.89-7.87), 63.22%], mechanical ventilation [1.64 (1.24-2.16), 68.00%], positive results from blood culture [1.60 (1.35-1.89), 41.19%], and a history of smoking [1.60 (1.09-2.36), 43.09%]. Other risk factors included cardiovascular diseases, coronary artery diseases, liver diseases, unknown infections, the administration of diuretics and ACEI/ARB, infection caused by gram-negative bacteria, and organ transplantation.Conclusion: Risk factors of S-AKI arise from a wide range of sources, making it difficult to predict and prevent this condition. Comorbidities, and certain drugs, are the main risk factors for S-AKI. Our review can provide guidance on the application of interventions to reduce the risks associated with sepsis-associated acute kidney injury and can also be used to tailor patient-specific treatment plans and management strategies in clinical practice.

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Rates, predictors and mortality of sepsis-associated acute kidney injury: systematic review and meta-analysis

10.21203/rs.3.rs-18145/v3 ◽

2020 ◽

Author(s):

Jie feng Liu ◽

Hebin Xie ◽

ziwei ye ◽

Lesan Wang

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Septic Shock ◽

Acute Kidney Injury ◽

Meta Analysis ◽

Kidney Injury ◽

Predisposing Factors ◽

Cochrane Library ◽

Patient Specific ◽

Cumulative Number

Abstract Objective:The incidence and mortality of sepsis-induced acute kidney injury is high. Many studies have explored the causes of sepsis-induced acute kidney injury (AKI). However, its predictors are still uncertain; additionally, a complete overview is missing. A systematic review and a meta-analysis were performed to determine the predisposing factors for sepsis-induced AKI. Method: A systematic literature search was performed in the Medline, Embase, Cochrane Library, PubMed and Web of Science databases, with an end date parameter of May 25, 2019. Valid data were retrieved in compliance with the inclusion and exclusion criteria. Result: Forty-seven observational studies were included for analysis. A cumulative number of 55911sepsis patients were evaluated. The incidence of AKI caused by septic shock is the highest. 30 possible risk factors were included in the meta-analysis. The results showed that 20 factors were found to be significant. The odds ratio(OR),95% confidence interval (CI) and Prevalence of the most prevalent predisposing factors for sepsis-induced AKI were as the following: Septic shock[2.88(2.36-3.52), 60.47%], Hypertension[1.43(1.20-1.70),38.39%), Diabetes mellitus[1.59(1.47-1.71),27.57%],Abdominal infection[1.44(1.32-1.58),30.87%], Vasopressors use[2.95(1.67-5.22),64.61%],vasoactive drugs use [3.85(1.89-7.87),63.22%], Mechanical ventilation[1.64(1.24-2.16),68.00%), Positive blood culture[1.60(1.35-1.89), 41.19%], Smoke history[1.60(1.09-2.36),43.09%]. Other risk factors include cardiovascular, coronary artery disease, liver disease, unknow infection, diuretics use, ACEI or ARB, gram-negative bacteria and organ transplant. Conclusion: A large number of factors are associated with AKI development in sepsis patients. Our review can guide risk-reducing interventions, clinical prediction rules, and patient-specific treatment and management strategies for sepsis-induced acute kidney injury.

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Protein-Energy Wasting Assessment and Clinical Outcomes in Patients with Acute Kidney Injury: A Systematic Review with Meta-Analysis

Nutrients ◽

10.3390/nu12092809 ◽

2020 ◽

Vol 12 (9) ◽

pp. 2809

Author(s):

Ban-Hock Khor ◽

Hui-Ci Tiong ◽

Shing Cheng Tan ◽

Raha Abdul Rahman ◽

Abdul Halim Abdul Gafor

Keyword(s):

Systematic Review ◽

Acute Kidney Injury ◽

Clinical Outcomes ◽

Nutritional Assessment ◽

Meta Analysis ◽

Kidney Injury ◽

Cochrane Library ◽

Protein Energy Wasting ◽

Nutritional Parameters ◽

Protein Energy

Nutritional assessment is essential to identify patients with acute kidney injury (AKI) who are protein-energy wasting (PEW) and at risk of poor clinical outcomes. This systematic review aimed to investigate the relationship of nutritional assessments for PEW with clinical outcomes in patients with AKI. A systematic search was performed in PubMed, Scopus, and Cochrane Library databases using search terms related to PEW, nutrition assessment, and AKI to identify prospective cohort studies that involved AKI adult patients with at least one nutritional assessment performed and reported relevant clinical outcomes, such as mortality, length of stay, and renal outcomes associated with the nutritional parameters. Seventeen studies reporting eight nutritional parameters for PEW assessment were identified and mortality was the main clinical outcome reported. A meta-analysis showed that PEW assessed using subjective global assessment (SGA) was associated with greater mortality risk (RR: 1.99, 95% CI: 1.36–2.91). Individual nutrition parameters, such as serum chemistry, body mass, muscle mass, and dietary intakes, were not consistently associated with mortality. In conclusion, SGA is a valid tool for PEW assessment in patients with AKI, while other nutrition parameters in isolation had limited validity for PEW assessment.

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Prevalence of acute kidney injury after cardiac surgery:A systematic review and meta-analysis on risk factors and different diagnostic criterias(AKIN,RIFLE,KDIGO)

10.21203/rs.2.17474/v1 ◽

2019 ◽

Author(s):

Alii Alidadii ◽

Morteza Salarzaei ◽

Fatem Parooe

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Acute Kidney Injury ◽

Cardiac Surgery ◽

Meta Analysis ◽

Kidney Injury ◽

World Health ◽

Cochrane Library ◽

Common Symptom ◽

Total Prevalence

Abstract Objective: This systematic review and meta-analysis aimed to determine the incidence and some of risk factors of AKI after cardiac surgery using all three diagnostic criteria (AKIN,RIFLE, and KIDGO).Method: We searched for published literature in the English language in MEDLINE via PubMed, EMBASETM via Ovid, The Cochrane Library, and Trip database. For literature published in other languages, we searched national databases (Magiran and SID) , KoreaMed and LILACS, and we searched OpenGrey (www.opengrey.eu/) and the World Health Organization Clinical Trials Registry (who.int/ictrp) for unpublished literature and ongoing studies.To ensure the literature saturation, the list of the included research references or the relevant reviews found by searching was studied(MS). The keywords used in the search strategy were Acute kidney injury,acute renal failure, creatinine,cardiac surgery,heart surgury, Coronary artery bypass grafting(CABG),valve replacement,RIFLE (risk, injury, failure, loss, end-stage renal disease) ,Acute Kidney Injury Network (AKIN),KDIGO (Kidney Disease: Improving Global Outcomes) , which were combined using the AND, OR, and NOT operators.Results: A total of 33298 patients who had undergone the cardiac surgery were studied. Based on the random effect model the total prevalence of AKI in 33298 patients undergone the heart surgery was 26.3% (95% confidence interval[CI]:26.1%,26.6%, I2=99.5%). the total prevalence of AKI in patients undergone cardiac surgery based on AKIN criteria was 21.6% (95% CI –21.2%, 22.1%,I2=98.5%) of whom 21.6% (95% CI-21.2%,22.1%,I2=98.5%) were classified as AKIN stage 1, whereas 3% (95% CI-2.7%%,3.4%%,I2=90.6%) were classified as AKIN stage 2, and 3.2% (95% CI-3.0%%,3.4%%,I2=97.2%) were classified as AKIN stage 3. the total prevalence of AKI in patients undergone cardiac surgery based on RIFLE criteria was 26.0%% (95% CI –25.6%, 26.5%,I2=99.4%). total prevalence of AKI in patients undergone cardiac surgery based on KDIGO criteria was 34.7% (95% CI –33.8%, 35.7%,I2=98.4%). the highest prevalence of AKI in patients undergone cardiac surgery was in Brazil 45.7% (95% CI –43.6%, 47.8%) based on 3 articles included followed by USA with a prevalence of 29.6%(95% CI –28.7%, 29.4%) based on 7 articles included, Uruguay with a prevalence of 36.1%(95% CI –35%, 37.2%) based on 1 article, Canada with a prevalence of 16.7%(95% CI –15.7%, 17.6%) based on 4 articles included and Italy with a prevalence of 10.6%(95% CI –9.8%, 11.3%) based on 3 articles included.Conclusion: AKI after cardiac surgery is a common symptom, although most often more severe in elderly patients. The prevalence of AKI after cardiac surgery based on KDIGO criteria was found to be higher than RIFLE and AKIN. The prevalence of AKI regardless of the definition used showed a decreasing trend from 2009 to 2019. Our findings pointed to the superiority of the KDIGO criterion over RIFLE and AKIN for diagnosing and evaluating AKI after cardiac surgery. However, the widespread acceptance of consensus definitions ( RIFLE and AKIN criteria) for AKI is still reflected in the studies. In order to progress further, establishment of a uniform definition for AKI seems necessary.

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Delayed Nephrology Consultation and High Mortality on Acute Kidney Injury: A Meta-Analysis

Blood Purification ◽

10.1159/000452316 ◽

2016 ◽

Vol 43 (1-3) ◽

pp. 57-67 ◽

Cited By ~ 24

Author(s):

Débora M. Soares ◽

José F. Pessanha ◽

Aashish Sharma ◽

Alessandra Brocca ◽

Claudio Ronco

Keyword(s):

Acute Kidney Injury ◽

High Mortality ◽

Task Force ◽

Early Recognition ◽

Meta Analysis ◽

Kidney Injury ◽

Care Practice ◽

Cochrane Central Register ◽

Central Register ◽

Substantial Morbidity

Background: Acute kidney injury (AKI) is a complex syndrome associated with substantial morbidity, mortality and costs. Despite advancements in diagnosis and care practice, AKI remains a disorder usually under/late-recognized with high mortality. One of the hidden reasons for poor outcome might be delayed nephrology consultation, with the involvement of the specialist only in severe stages of AKI when renal replacement therapy (RRT) is required. Methods: We searched PubMed, EMBASE and Cochrane central register for related work on the subject. Six studies were identified for the meta-analysis, correlating time of nephrology consultation and mortality in AKI. Results: We found that delayed nephrology consultation is associated with higher mortality in AKI, with an OR 0.79 (95% CI 0.48-1.10, p < 0.05). Conclusion: Delayed nephrology consultation contributes to higher mortality in AKI. The early involvement of nephrologist may present an advantage in terms of early recognition, prevention and effective treatment of AKI. An early involvement of multidisciplinary task force may contribute to better treatment, before the preventable complications of AKI occur or an emergency RRT is required.

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The Predictive Value of Urinary Kidney Injury Molecular 1 for the Diagnosis of Contrast-Induced Acute Kidney Injury after Cardiac Catheterization: A Meta-Analysis

Journal of Interventional Cardiology ◽

10.1155/2020/4982987 ◽

2020 ◽

Vol 2020 ◽

pp. 1-9

Author(s):

Qing Li ◽

Yimin Huang ◽

Weifeng Shang ◽

Ying Zhang ◽

Yanyan Liu ◽

...

Keyword(s):

Acute Kidney Injury ◽

Cardiac Catheterization ◽

Predictive Value ◽

Meta Analysis ◽

Characteristic Curve ◽

Kidney Injury ◽

Population Characteristics ◽

Cochrane Library ◽

China National Knowledge Infrastructure ◽

Summary Receiver Operating Characteristic

Background. Urinary kidney injury molecule 1 (uKIM-1) is a proximal tubular injury biomarker for predicting acute kidney injury (AKI); its prognostic value varies depending on the clinical and population characteristics. However, the predictive value of uKIM-1 for diagnosis of contrast-induced acute kidney injury (CI-AKI) remains unclear. Method. Medline, Embase, ClinicalTrials.gov, Cochrane Library database, and the China National Knowledge Infrastructure (CNKI) were used to identify relevant studies from their inception to November 31, 2019. Studies that met the inclusion criteria were included. Relevant data were extracted to obtain pooled sensitivity (SEN) and specificity (SPE), summary receiver operating characteristic curve (ROC), and area under the ROC (AUC or AUROC). A bivariate mixed-effects regression model was used for data analysis. Results. A total of 946 patients from 8 eligible studies were included. Across all the studies, the diagnostic odds ratio (DOR) for uKIM-1 level to predict CI-AKI was 19 (95% CI 10–39), with SEN and SPE of 0.84 and 0.78, respectively. The AUROC for uKIM-1 in predicting CI-AKI was 0.88 (95% CI 0.85–0.90). There was a substantial heterogeneity across the studies (I2 was 37.73% for the summary sensitivity and 69.31% for the summary specificity). Conclusion. Urinary KIM-1 has a high predictive value for diagnosis of CI-AKI in patients who have undergone cardiac catheterization.

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Hydration Strategies for Preventing Contrast-Induced Acute Kidney Injury: A Systematic Review and Bayesian Network Meta-Analysis

Journal of Interventional Cardiology ◽

10.1155/2020/7292675 ◽

2020 ◽

Vol 2020 ◽

pp. 1-16

Author(s):

Qiuping Cai ◽

Ran Jing ◽

Wanfen Zhang ◽

Yushang Tang ◽

Xiaoping Li ◽

...

Keyword(s):

Acute Kidney Injury ◽

Sodium Chloride ◽

Sodium Bicarbonate ◽

Optimal Strategy ◽

Meta Analysis ◽

Kidney Injury ◽

Cochrane Library ◽

Oral Hydration ◽

Ovid Medline ◽

Risk Patients

Aims. Many previous studies have examined the effect of different hydration strategies on prevention of contrast-induced acute kidney injury (CI-AKI), but the optimal strategy is unknown. We performed a network meta-analysis (NWM) of these previous studies to identify the optimal strategy. Methods and Results. Web of Science, PubMed, OVID Medline, and Cochrane Library were searched from their inception dates to September 30, 2018. Randomized controlled trials (RCTs) were selected based on strict inclusion criteria, and a Bayesian NWM was performed using WinBUGS V.1.4.3. We finally analyzed 60 eligible RCTs, which examined 21,293 patients and 2232 CI-AKI events. Compared to intravenous 0.9% sodium chloride (reference), intravenous sodium bicarbonate (OR [95% CI]: 0.74 [0.57, 0.93]), hemodynamic guided hydration (0.41 [0.18, 0.93]), and RenalGuard guided hydration (0.32 [0.14, 0.70]) significantly reduced the occurrence of CI-AKI. Oral hydration and intravenous 0.9% sodium chloride were each noninferior to no hydration in preventing CI-AKI. Intravenous 0.9% sodium chloride, sodium bicarbonate, and hemodynamic guided hydration were each noninferior to oral hydration in preventing CI-AKI. Based on surface under the cumulative ranking curve values, the RenalGuard system was best (0.974) and hemodynamic guided hydration was second best (0.849). Conclusion. There was substantial evidence to support the use of RenalGuard or hemodynamic guided hydration for preventing CI-AKI in high-risk patients, especially those with chronic kidney disease or cardiac dysfunction.

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Visualizing Glioma Infiltration by the Combination of Multimodality Imaging and Artificial Intelligence, a Systematic Review of the Literature

Diagnostics ◽

10.3390/diagnostics11040592 ◽

2021 ◽

Vol 11 (4) ◽

pp. 592

Author(s):

Sabrina Honoré d’Este ◽

Michael Bachmann Nielsen ◽

Adam Espe Hansen

Keyword(s):

Artificial Intelligence ◽

Tumor Cell ◽

Multimodality Imaging ◽

Meta Analysis ◽

Area Under The Curve ◽

Radiotherapy Planning ◽

Cell Infiltration ◽

Cochrane Library ◽

Resection Margins ◽

Test Accuracy

The aim of this study was to systematically review the literature concerning the integration of multimodality imaging with artificial intelligence methods for visualization of tumor cell infiltration in glioma patients. The review was performed in accordance with the preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines. The literature search was conducted in PubMed, Embase, The Cochrane Library and Web of Science and yielded 1304 results. 14 studies were included in the qualitative analysis. The reference standard for tumor infiltration was either histopathology or recurrence on image follow-up. Critical assessment was performed according to the Quality Assessment of Diagnostic Accuracy Studies (QUADAS2). All studies concluded their findings to be of significant value for future clinical practice. Diagnostic test accuracy reached an area under the curve of 0.74–0.91 reported in six studies. There was no consensus with regard to included image modalities, models or training and test strategies. The integration of artificial intelligence with multiparametric imaging shows promise for visualizing tumor cell infiltration in glioma patients. This approach can possibly optimize surgical resection margins and help provide personalized radiotherapy planning.

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Risk Factors for Acute Kidney Injury in Adult Patients With COVID-19: A Systematic Review and Meta-Analysis

Frontiers in Medicine ◽

10.3389/fmed.2021.719472 ◽

2021 ◽

Vol 8 ◽

Author(s):

Xiaoyue Cai ◽

Guiming Wu ◽

Jie Zhang ◽

Lichuan Yang

Keyword(s):

Risk Factors ◽

Cardiovascular Disease ◽

Mechanical Ventilation ◽

Acute Kidney Injury ◽

Meta Analysis ◽

Significant Risk ◽

Kidney Injury ◽

Adult Patients ◽

Cochrane Library ◽

Male Sex

Background and Objective: Since December 2019, coronavirus disease 2019 (COVID-19) has spread rapidly around the world. Studies found that the incidence of acute kidney injury (AKI) in COVID-19 patients was more than double the incidence of AKI in non-COVID-19 patients. Some findings confirmed that AKI is a strong independent risk factor for mortality in patients with COVID-19 and is associated with a three-fold increase in the odds of in-hospital mortality. However, little information is available about AKI in COVID-19 patients. This study aimed to analyse the risk factors for AKI in adult patients with COVID-19.Methods: A systematic literature search was conducted in PubMed, EMBASE, Web of Science, the Cochrane Library, CNKI, VIP and WanFang Data from 1 December 2019 to 30 January 2021. We extracted data from eligible studies to compare the effects of age, sex, chronic diseases and potential risk factors for AKI on the prognosis of adult patients with COVID-19.Results: In total, 38 studies with 42,779 patients were included in this analysis. The meta-analysis showed that male sex (OR = 1.37), older age (MD = 5.63), smoking (OR = 1.23), obesity (OR = 1.12), hypertension (OR=1.85), diabetes (OR=1.71), pneumopathy (OR = 1.36), cardiovascular disease (OR = 1.98), cancer (OR = 1.26), chronic kidney disease (CKD) (OR = 4.56), mechanical ventilation (OR = 8.61) and the use of vasopressors (OR = 8.33) were significant risk factors for AKI (P < 0.05).Conclusions: AKI is a common and serious complication of COVID-19. Overall, male sex, age, smoking, obesity, hypertension, diabetes, pneumopathy, cardiovascular disease, cancer, CKD, mechanical ventilation and the use of vasopressors were independent risk factors for AKI in adult patients with COVID-19. Clinicians need to be aware of these risk factors to reduce the incidence of AKI.System Review Registration: PROSPERO, identifier [CRD42021282233].

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Acute kidney injury is associated with severe and fatal outcomes in patients with Coronavirus disease 2019 (COVID-19) infection: a systematic review and meta-analysis of observational studies

10.1101/2020.08.27.20183632 ◽

2020 ◽

Author(s):

Mohammad Parohan ◽

Sajad Yaghoubi ◽

Mahmoud Djalali ◽

Asal Seraji ◽

Mohammad Hassan Javanbakht ◽

...

Keyword(s):

Acute Kidney Injury ◽

Disease Severity ◽

Fixed Effects ◽

Weighted Mean Difference ◽

Meta Analysis ◽

Kidney Injury ◽

Cochrane Library ◽

Pool Data ◽

Fixed Effects Model ◽

Death Cases

Coronavirus disease 2019 (COVID-19) is a pandemic impacting 213 countries and territories with more than 17,918,582 cases worldwide. Kidney dysfunction has been reported to occur in severe and death cases. This meta-analysis was done to summarize available studies on the association between acute kidney injury and severity of COVID-19 infection. Online databases including Web of Science, PubMed/Medline, Cochrane Library, Scopus and Google Scholar were searched to detect relevant articles up to 1 July 2020, using relevant keywords. To pool data, a random- or fixed-effects model was used based on the heterogeneity between studies. In total, 50 studies with 8,180 COVID-19 confirmed cases (severe cases=1,823 and death cases=775), were included in this meta-analysis. Higher serum levels of creatinine (weighted mean difference (WMD) for disease severity=5.47 μmol/L, 95% CI=2.89 to 8.05, P<0.001 and WMD for mortality=18.32 μmol/L, 95% CI=12.88 to 23.75, P<0.001), blood urea nitrogen (BUN) (WMD for disease severity=1.10 mmol/L, 95% CI=0.67 to 1.54, P<0.001 and WMD for mortality=3.56 mmol/L, 95% CI=2.65 to 4.48, P<0.001) and lower levels of estimated glomerular filtration rate (eGFR) (WMD for disease severity=-15.34 mL/min/1.73 m2, 95% CI=-18.46 to -12.22, P<0.001 and WMD for mortality=-22.74 mL/min/1.73 m2, 95% CI=-27.18 to -18.31, P<0.001) were associated with a significant increase in the severity and mortality of COVID-19 infection. Acute kidney injury, as assessed by kidney biomarkers (serum creatinine, BUN and eGFR), was associated with severe outcome and death from COVID-19 infection.

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