Continuous Urine Output-Based Alert Identifies Cardiac Surgery-associated Acute Kidney Injury Earlier Than Serum Creatinine: A Prospective and Retrospective Observational Study.

Acute kidney injury (AKI) is defined and staged by reduced urine output (UO) and increased serum creatinine (SCr). UO is typically measured manually and documented in the electronic health record, making early and reliable detection of oliguria-based AKI and electronic data extraction challenging. The authors investigated the diagnostic performance of continuous UO, enabled by active drain line clearance-based alerts (Accuryn AKI Alert), compared with AKI stage 2 SCr criteria and their associations with length of stay, need for continuous renal replacement therapy, and 30-day mortality. This study was a prospective and retrospective observational study. Nine tertiary centers participated. Cardiac surgery patients were enrolled. None. A total of 522 patients were analyzed. AKI stages 1, 2, and 3 were diagnosed in 32.18%, 30.46%, and 3.64% of patients based on UO, compared with 33.72%, 4.60%, and 3.26% of patients using SCr, respectively. Continuous UO-based alerts diagnosed stage ≥1 AKI 33.6 (IQR =15.43, 95.68) hours before stage ≥2 identified by SCr criteria. A SCr-based diagnosis of AKI stage ≥2 has been designated a Hospital Harm by the Centers for Medicare & Medicaid Services. Using this criterion as a benchmark, AKI alerts had a discriminative power of 0.78. The AKI Alert for stage 1 was significantly associated with increased intensive care unit and hospital length of stay and continuous renal replacement therapy, and stage ≥2 alerts were associated with mortality. AKI Alert, based on continuous UO and enabled by active drain line clearance, detected AKI stages 1 and 2 before SCr criteria. Early AKI detection allows for early kidney optimization, potentially improving patient outcomes.

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Déclaration de conflit d'intérêts

Declaration of competing interest V. Moll is a paid consultant for Acccuryn Medical. M. Zhao, S. Minear, A. Kurz, and M. Swaminathan declare no support from any organization for the submitted work, no financial relationships with any organizations that might have an interest in the submitted work in the previous three years, and no other relationships or activities that could appear to have influenced the submitted work. A. K. Khanna is a paid consultant for and chairs the steering committee for the Predict AKI Group for Accuryn Medical and consults for Edwards Lifesciences, Medtronic, Philips North America, GE Healthcare, Retia Medical, Pharmazz Inc., Hill-Rom, and Caretaker Medical. His institution has grant funding from Caretaker Medical for ongoing investigations on portable hemodynamic monitoring. A. K. Khanna is on the executive advisory board for Medtronic, Philips Hemodynamics Safety, and Retia Medical and receives support from the Wake Forest CTSI via NIH/NCATS KL2 for a trial of continuous portable hemodynamic and saturation monitoring in hospital wards. K. Stanton is employed by Accuryn Medical, Hayward, CA, USA. J. Huang received research funding from Acccuryn Medical, Mespere LifeSciences, and GE Healthcare and is a consultant for GE Healthcare and Medtronic. K. G. Parr is a paid consultant for FlexiCare and NorthGauge.