Toward the standardization of big datasets of urine output for AKI analysis: a multicenter validation study

Abstract Acute kidney injury (AKI) is a prevalent condition in ICU patients. However, inconsistencies in urine charting and guideline interpretations hinder accurate diagnosis and research. This study aimed to derive and validate a standardization for the processing of big urine output datasets to improve consistency in AKI diagnosis and staging. Using a derivation cohort from 14 ICUs at Beth Israel Deaconess Medical Center (2008–2019) and a validation cohort from an academic center in Amsterdam (2003–2016), we developed and validated an algorithm for computing hourly urine output rates and identifying oliguric AKI across its definitions. Peak AKI stages computed using the method were significantly associated with all clinical outcomes, including severity scores, serum creatinine levels, ICU and hospital lengths of stay, renal replacement therapy requirements, and hospital mortality (all p < 0.001). Adjusted 30-day mortality odds ratios for AKI stages 1–3 were 1.58, 2.93, and 5.24 in the derivation cohort and 2.91, 5.16, and 13.59 in the validation cohort (all p < 0.001). Tested on over 85,000 multinational ICU admissions, this approach demonstrated robust performance and consistent results across diverse settings; it has the potential to enhance clinical practice through e-alerts and support future AKI and fluid balance research, including ML model training and inference. Supported by open-source code, the proposed method advances the standardization of AKI diagnostic criteria and can be applied to other EHR-based databases

Blood Stream Infections in Burns: A 14-Year Cohort Analysis

Background: Blood stream infections are a significant cause of morbidity and mortality in burns, and pathogen identification is important for treatment. This study aims to characterize the microbiology of these infections and the association between the infecting pathogen and the hospitalization course. Methods: We conducted a cohort study that included records of burn patients treated at the Soroka University Medical Center between 2007–2020. Statistical analysis of demographic and clinical data was performed to explore relationships between burn characteristics and outcomes. Patients with positive blood cultures were divided into four groups: Gram-positive, Gram-negative, mixed-bacterial, and fungal. Results: Of the 2029 burn patients hospitalized, 11.7% had positive blood cultures. The most common pathogens were Candida and Pseudomonas. We found significant differences in ICU admission, need for surgery, and mortality between the infected and non-infected groups (p p p p < 0.001). Conclusions: Anticipating specific pathogens which are associated with certain burn characteristics may help guide future therapy