Abstract: FR-PO053
Development of Urinalysis Screening Criteria for Electronic Health Alerts for Rhabdomyolysis
Session Information
- AKI: Epidemiology, Risk Factors, and Prevention - 2
October 25, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 101 AKI: Epidemiology, Risk Factors, and Prevention
Authors
- Yasmin, Farah, Yale University School of Medicine, New Haven, Connecticut, United States
- Faulkner, Sophia, Yale University School of Medicine, New Haven, Connecticut, United States
- Aklilu, Abinet Mathias, Yale University School of Medicine, New Haven, Connecticut, United States
- Yamamoto, Yu, Yale University School of Medicine, New Haven, Connecticut, United States
- Moledina, Dennis G., Yale University School of Medicine, New Haven, Connecticut, United States
- Wilson, Francis Perry, Yale University School of Medicine, New Haven, Connecticut, United States
Group or Team Name
- Clinical and Translational Research Accelerator (CTRA).
Background
Acute kidney injury (AKI) is present in 7-10% of rhabdomyolysis (rhabdo) cases and early intervention can improve outcomes. A discrepancy between heme on dipstick and RBC on microscopy on UA can potentially aid in early rhabdo diagnosis.
Methods
We did a retrospective electronic chart review of adult inpatients hospitalized between Jan 2020-Dec 2022 who met KDIGO-creatinine criteria for AKI, had UA within the same hospitalization pre-AKI, no rhabdo suspicion (i.e., no creatine kinase (CK) test pre-AKI), and no lab evidence of hemolysis.16 screening criteria were formulated to identify individuals at elevated likelihood of rhabdo using combinations of heme ≥1+, ≥ 2+, ≥ 3+, ≥ 4+ and RBC ≤5, ≤10, ≤20, ≤30 thresholds whose accuracy was assessed using post-AKI CK>500 U/L as the definition of rhabdo diagnosis.
Results
A total of 12,284 patients were included of which 20.5% had serum CK levels checked. Of those, 17.4% (440) met the diagnostic criteria for rhabdo. Rhabdo patients had significantly higher incidence of mortality, dialysis, and AKI progression. The median (IQR) time between UA and AKI was 1.97 (4.55-0.84) days. UA criteria of ≥1 heme + ≤30 RBCs (met by 35.1% of patients) had the highest sensitivity for rhabdo (63.4%). Within this criterion, a quarter (1079/4308) had their CK checked, of whom a quarter (279/1079) had CK levels consistent with rhabdo. The UA criteria of ≥ 3+ heme + ≤5 RBCs (met by 2.0% (246) patients) had a specificity of 97.2% and sensitivity of 11.2%. This criterion included the highest proportion of patients with CK measurement (111/246, 45.1%), and nearly half of those tested (52/111) had levels consistent with rhabdo (Fig. 1).
Conclusion
CK testing was overall uncommon under all definitions, suggesting missed rhabdo cases. As UA is obtained frequently in AKI workup (and other conditions) automated electronic screening of UA parameters with clinical decision support to order CK may be a viable mechanism to increase the diagnosis of rhabdo.