• Emma Schwager, Stephanie Lanius, Erina Ghosh, Larry Eshelman, Kalyan S Pasupathy, Erin F Barreto, and Kianoush Kashani.
• Philips Research North America, Cambridge, MA, USA.
• J Crit Care. 2021 Apr 1; 62: 283-288.

PurposeAcute kidney injury (AKI) is a prevalent and detrimental condition in intensive care unit patients. Most AKI predictive models only predict creatinine-triggered AKI (AKICr) and might underperform when predicting urine-output-triggered AKI (AKIUO). We aimed to describe how admission AKICr prediction models perform in all AKI patients.Materials And MethodsThree types of models were trained: 1) pAKIany, predicting AKI based on creatinine or urine output, 2) pAKIUO, predicting AKI based only on urine output, and 3) pAKICr, predicting AKI based only on creatinine. We compared model performance and predictive features.ResultsThe pAKIany models had the best overall performance (AUROC 0.673-0.716) and the most consistent performance across three patient cohorts grouped by type of AKI trigger (min AUROC of 0.636). The pAKICr models had fair performance in predicting AKICr (AUROCs 0.702-0.748) but poor performance predicting AKIUO (AUROCs 0.581-0.695). The predictive features for the pAKICr models and pAKIUO models were distinct, while top features for the pAKIany models were consistently a combination of those for the pAKICr and pAKIUO models.ConclusionIgnoring urine output in the outcome during model training resulted in models that are unlikely to predict AKIUO adequately and may miss a substantial proportion of patients in practice.Copyright © 2021 Elsevier Inc. All rights reserved.

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