一种方法来表征从急性损伤到慢性病的疾病进展
Yilu Fang1, Jordan G Nestor2, Casey N Ta1
1Department of Biomedical Informatics, Columbia University, New York, NY, USA.
Journal of biomedical informatics
|November 14, 2025
概括
在急性损伤 (AKI) 后,识别患有慢性病 (CKD) 高风险的患者至关重要. 这项研究使用电子健康记录来定义不同的AKI后状态,并预测CKD的发展.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學專業.
- 在医疗保健中的数据科学.
- 临床信息学 临床信息学
背景情况:
- 急性损伤 (AKI) 显著增加患慢性病 (CKD) 的风险.
- 早期识别高风险的AKI患者的CKD发展是具有挑战性的.
- 电子健康记录 (EHR) 为跟踪患者发展轨迹提供了宝贵的资源.
研究的目的:
- 动态跟踪AKI患者的临床演变.
- 描述从AKI到CKD的进展情况.
- 识别与AKI-CKD过渡相关的不同临床状态和风险因素.
主要方法:
- 从纵向EHR数据 (医疗代码,肌素) 中对患者载体进行分组.
- 多状态建模以估计AKI后状态和CKD发展之间的过渡概率.
- 存活率分析以确定AKI亚群中的CKD风险因素.
主要成果:
- 在20699名AKI患者中,有17%患有CKD.
- 确定了15个不同的AKI后临床状态,每个临床状态都有不同的CKD进展概率.
- 确定了既定和新型CKD风险因素,在确定的国家之间产生不同的影响.
结论:
- 使用EHR数据的数据驱动方法可以有效地识别AKI后不同的临床状态.
- 这种方法支持开发用于早期发现CKD的决策支持工具.
- 早期干预策略可以根据已识别的高风险AKI患者亚群量身定制.
相关概念视频
Acute Kidney Injury III: Clinical Manifestations
791
Acute Kidney Injury (AKI) progresses through distinct clinical phases: the oliguric, diuretic, and recovery phases, each marked by unique manifestations and challenges.Oliguric Phase:The oliguric phase is the initial stage of AKI, typically lasting 10 to 14 days. This phase is marked by a significant reduction in urine output, usually less than 400 mL per day, indicating decreased kidney function. Fluid retention is a prominent feature, leading to symptoms such as edema, hypertension, and...
791
Acute Kidney Injury I: Introduction
549
Introduction:Acute Kidney Injury (AKI) describes a swift decrease in kidney function occurring over hours to days, characterized by the kidneys' failure to remove waste products from the bloodstream. This leads to dangerous complications like metabolic acidosis, fluid overload, and electrolyte imbalances, such as hyperkalemia, which can cause life-threatening arrhythmias. AKI is common in both hospital and outpatient settings, often triggered by dehydration, sepsis, or exposure to nephrotoxic...
549
Chronic Kidney Disease I: Introduction
552
Chronic Kidney Disease (CKD) arises when the kidneys progressively lose their ability to function, ultimately leading to end-stage renal disease. At this advanced stage, the kidneys can no longer filter waste or maintain essential body functions, requiring renal replacement therapy (RRT) through dialysis or a kidney transplant for survival.Early-stage chronic kidney disease and detection challengesIn CKD's early stages, symptoms often remain absent because healthy nephrons compensate for...
552
Chronic Kidney Disease III: Interprofessional Care
331
Chronic kidney disease (CKD) requires collaborative and comprehensive management. CKD progresses through stages and can lead to end-stage kidney disease (ESKD) if untreated. Interprofessional collaboration and patient education are crucial, enabling patients to manage their health and improve their quality of life.Diagnostic approach for chronic kidney diseaseThe diagnosis of CKD primarily focuses on the glomerular filtration rate (GFR), which assesses kidney function by measuring how well...
331
Acute Kidney Injury IV: Diagnostic Studies and Prevention
254
Accurate diagnosis and effective prevention are critical in managing Acute Kidney Injury (AKI), which is linked to high mortality rates ranging from 10% to 80%. Timely recognition of at-risk patients and careful monitoring can significantly reduce the likelihood of kidney damage.Diagnostic Assessments:The diagnostic process starts with a comprehensive medical history to identify prerenal, intrarenal, and postrenal causes.Prerenal causes, such as dehydration, hypotension, or blood loss, should...
254
Acute Kidney Injury II: Pathophysiology
865
Acute kidney injury (AKI) causes are categorized into three primary categories based on the location of the injury: prerenal, intrarenal (or intrinsic), and postrenal causes. This classification guides clinical management and illustrates how different pathways can impair kidney function.Etiology and Pathophysiology of Acute Kidney Injury1. Prerenal causesEtiology: Prerenal Acute Kidney Injury, the most common type, occurs when reduced blood flow to the kidneys decreases filtration capacity...
865


