The Effect of Care Bundles for AKI: A Systematic Review and Meta-Analysis
Bibliographic record
Abstract
Background: Acute kidney injury (AKI) is common and associated with increased morbidity and mortality. Implementation a set of evidence-based AKI care bundles may have some benefits to patient outcomes by reducing variable standards of care. We aimed to systematically review the literature to quantify the effect of AKI care bundles on patient outcomes. Methods: We searched Pubmed (Medline), EMBASE and Cochrane databases for studies that compare the effect of AKI care bundles with usual standard care in patients with or at risk of AKI from database inception to December 31, 2019. The quality of included studies was assessed using the Newcastle-Ottawa Scale. Heterogeneity was assessed using Cochrane Q test and I2 test statistics. Data were analyzed by RevMan 5.3 and Comprehensive meta-analysis (CMA 3.0). The primary outcome was in-hospital or longest follow-up mortality. Secondary outcomes included AKI incidence and AKI severity. Results: A total of 11 studies (23,491 patients) were included in the meta-analysis. The implementation of AKI care bundles significantly reduced mortality in all patients (odds ratio, 0.87; 95% CI, 0.79-0.94; P =0.001; I2 = 0%; Fig 1). And in patients at high risk for AKI(identified by novel biomarker, risk prediction score or electronic alert), care bundles significantly reduced AKI incidence(odds ratio, 0.62; 95% CI, 0.44-0.86; P=0.005; I2 = 70%; Fig 2) and rates of AKI severity (odds ratio, 0.52; 95% CI, 0.35-0.76; P<0.001; I2= 41%; Fig 3). In addition, there was no evidence of publication bias among the included studies.Fig. 1: Forest plot of effect of AKI care bundles on mortality.Fig. 2: Forest plot of effect of AKI care bundles on AKI incidence in patients at risk of AKI.Fig. 3: Forest plot of effect of AKI care bundles on AKI severity in patients at risk of AKI.Conclusions: The introduction of AKI care bundles can effectively improve outcome in patients with or at risk of AKI, especially when combined with novel biomarker, risk prediction score or electronic alert to manage AKI at early stage. However, the evidence so far is limited and not strong enough to make definite conclusions.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.019 | 0.043 |
| Meta-epidemiology (narrow) | 0.004 | 0.002 |
| Meta-epidemiology (broad) | 0.026 | 0.059 |
| Bibliometrics | 0.009 | 0.008 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.004 | 0.003 |
| Open science | 0.003 | 0.002 |
| Research integrity | 0.003 | 0.003 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".