• Mark Thomas, Alice Sitch, and George Dowswell.
• 1Department of Renal Medicine, Birmingham Heartlands Hospital, Bordesley Green East B9 5SS, UK. mark.thomas@heartofengland.nhs.uk
• Nephrol. Dial. Transplant. 2011 Jul 1;26(7):2161-8.

BackgroundAcute kidney injury (AKI) recognition by clinicians has been shown to be suboptimal. Little work has focused on the use of an automated warning of a rise in a patient's creatinine, indicating AKI.MethodsOver 3 months in 2008 we ran a prospective observational study of 'alerts' sent by our Integrated Clinical Environment pathology system, identifying all patients with a ≥ 75% rise in their creatinine from its previous value. Information was collected on subsequent renal function, comorbidities and other potential predictors of survival.ResultsIn the 3-month period 463 adults with a first episode of AKI were identified by an alert; 87% were hospital inpatients. Median follow-up was 404 days. In-hospital mortality was 36% for those who were admitted. After performing Weibull survival analysis, significant predictors of poorer survival were the presence of metastatic, haematological or lower risk malignancy, a residential or nursing home address and higher age, number of non-malignant comorbidities or C-reactive protein level. Predictors of better survival were higher serum albumin level or nadir GFR during the episode and Indian subcontinent ethnicity. A receiver-operator curve for a prognostic score developed from the analysis showed an area under the curve of 0.84.ConclusionsThe alerts identified a group of AKI patients who are at moderately high risk of death. The prognostic score using a combination of covariates shows early promise. Both the alerts and the score warrant further development as tools for earlier intervention in AKI.

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