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. 2021 Feb 22;22(1):63.
doi: 10.1186/s12882-021-02238-9.

Assessment of acute kidney injury risk using a machine-learning guided generalized structural equation model: a cohort study

Wen En Joseph Wong  1 , Siew Pang Chan  2   3 , Juin Keith Yong  2 , Yen Yu Sherlyn Tham  2 , Jie Rui Gerald Lim  2 , Ming Ann Sim  4 , Chai Rick Soh  5 , Lian Kah Ti  2   4 , Tsong Huey Sophia Chew  2   5   6
Affiliations

Assessment of acute kidney injury risk using a machine-learning guided generalized structural equation model: a cohort study

Wen En Joseph Wong et al. BMC Nephrol. .

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.

Keywords: Acute kidney injury; Critically ill; Hemoglobin; Mortality; Surgery.

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Conflict of interest statement

The authors declare that they have no competing interests relevant to the paper.

Figures

Fig. 1
Fig. 1
CHAID analysis of the occurrence of ICU AKI. Abbreviations used: ICU = intensive care unit. AKI = acute kidney injury
Fig. 2
Fig. 2
Generalized structural equation model path diagram
Fig. 3
Fig. 3
Kaplan-Meier Analysis of Time-to-Death. *Abbreviations. ICU = intensive care unit . AKI = acute kidney injury
See this image and copyright information in PMC

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