Redefining urine output thresholds for acute kidney injury criteria in critically Ill patients: a derivation and validation study
Authors' conclusion
The proposed UO-AKI classification enhances mortality prediction and patient stratification in critically ill patients, offering a more accurate and practical approach than the current KDIGO criteria.
Study context
- Population
- Critically ill patients, MIMIC-IV (development) and eICU (validation) databasesdevelopment cohort
- Participants
- 35,845 patients
- Comparison
- Proposed UO-AKI classification vs KDIGO UO-AKI criteria
- Outcome
- Hospital mortality prediction
Methodological detailsretrospective database analysis, external validation
- Retrospective database analysis
- External validation
Performance
As reported in the abstract
Hospital mortality prediction (proposed classification with or without serum creatinine (sCr) vs KDIGO)
Net reclassification improvement (NRI)
25.4%
95% CI 23.3–27.6
Proposed UO-AKI classification
Integrated discrimination improvement (IDI)
4.0%
95% CI 3.6–4.5
Proposed UO-AKI classification
Proposed UO-AKI classification
0.75
0.74–0.76
AUC-ROC
KDIGO
0.69
0.68–0.70
AUC-ROC
Further findings
Average vs persistent reduced urinary output (UO) method
- Better discrimination with average than persistent method
Hospital mortality by UO-AKI stage
- Significant stepwise increase in adjusted OR for hospital mortality with advancing UO-AKI stage
External validation (eICU)
- Confirmed superior performance of new classification
Original publication
Redefining urine output thresholds for acute kidney injury criteria in critically Ill patients: a derivation and validation study. Crit Care. Published 12 August 2024. doi:10.
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