通过警报系统及早发现急性肾损伤可改善住院病人的预后。

IF 3.2 3区医学 Q2 MEDICAL LABORATORY TECHNOLOGY

Clinica Chimica Acta Pub Date : 2024-11-23 DOI:10.1016/j.cca.2024.120061

Raquel Galván , P. Fernandez-Riejos , C. Sánchez Mora , M. Salgueira Lazo , W. Aguilera Morales , A. Monzón , M. Jiménez Barragán , C. Rodriguez-Chacón , I. Almazo Guerrero , A. León Justel

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引用次数: 0

摘要

背景和目的：在医院环境中发生的急性肾损伤（AKI）已成为一个重要的公共卫生问题。急性肾损伤与住院时间延长、医疗费用增加、慢性肾病发病风险增加、死亡率上升以及住院后需要持续护理等因素有关。我们的假设表明，及时发现 AKI、找出其潜在原因并由专家进行专业处理，可改善住院患者的预后：我们设计了一个电子警报系统，该系统包含一个由医院多学科专业人员组成的团队监督的行动和后续计划。我们从住院时间、院内死亡率和肾功能改善等方面比较了患者在不同阶段的预后情况：结果：干预组近 80% 的患者在警报发出 48 小时后血清肌酐明显下降。非干预组的住院时间比干预组长：12 (8 - 20) 天 vs 10 (6 - 15) 天（p = 0.002），住院期间的死亡率也是如此：住院期间死亡率：34% 对 19.9%（P = 0.002）。非干预组的中位生存期估计为20（14--26）天，而干预组的中位生存期估计为33（20--45）天：我们的研究强调了在住院期间和住院后密切监测高危患者AKI的重要性。医护人员及时进行风险评估和干预，包括临床实验室的参与，可以改善 AKI 的预后。

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Early detection of acute kidney injury through an alert system improves outcomes in hospitalized patients

Background and Aims

Acute kidney injury (AKI) acquired in hospital settings has emerged as a significant public health issue. It is linked to prolonged hospital stays, increased healthcare costs, heightened risk of developing chronic kidney disease, mortality, and the need for ongoing post-hospitalization care. Our hypothesis suggests that timely recognition of AKI, identification of its underlying causes, and expert management by specialists could lead to improved prognoses for hospitalized patients.

Materials and methods

We have devised an electronic-alert system that incorporates an action and follow-up plan overseen by a multidisciplinary team of hospital professionals. We compared the prognosis of patients measured in terms of length of hospital stay, in-hospital mortality and improvement of renal function at different points.

Results

Almost 80 % of patients in the Intervention group had a significant decrease in serum creatinine 48 h after the alert. The length of hospital stay was longer in the Non-Intervention group than in the Intervention group: 12 (8 – 20) vs 10 (6 – 15) days (p = 0.002), as was mortality during hospitalization: 34 % of cases vs 19.9 % (p = 0.002). The median survival of the Non-Intervention group was estimated at 20 (14 – 26) days, while that of the Intervention group was estimated at 33 (20 – 45) days.

Conclusions

Our study highlights the importance of closely monitoring at-risk patients for AKI during and after hospitalization. Prompt risk assessment and interventions by healthcare professionals, including clinical laboratory involvement, could improve AKI prognosis.

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来源期刊

Clinica Chimica Acta 医学-医学实验技术

CiteScore

10.10

自引率

2.00%

发文量

1268

审稿时长

23 days

期刊介绍： The Official Journal of the International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) Clinica Chimica Acta is a high-quality journal which publishes original Research Communications in the field of clinical chemistry and laboratory medicine, defined as the diagnostic application of chemistry, biochemistry, immunochemistry, biochemical aspects of hematology, toxicology, and molecular biology to the study of human disease in body fluids and cells. The objective of the journal is to publish novel information leading to a better understanding of biological mechanisms of human diseases, their prevention, diagnosis, and patient management. Reports of an applied clinical character are also welcome. Papers concerned with normal metabolic processes or with constituents of normal cells or body fluids, such as reports of experimental or clinical studies in animals, are only considered when they are clearly and directly relevant to human disease. Evaluation of commercial products have a low priority for publication, unless they are novel or represent a technological breakthrough. Studies dealing with effects of drugs and natural products and studies dealing with the redox status in various diseases are not within the journal''s scope. Development and evaluation of novel analytical methodologies where applicable to diagnostic clinical chemistry and laboratory medicine, including point-of-care testing, and topics on laboratory management and informatics will also be considered. Studies focused on emerging diagnostic technologies and (big) data analysis procedures including digitalization, mobile Health, and artificial Intelligence applied to Laboratory Medicine are also of interest.