Table 3.
GRADE evidence profile.
| Certainty assessment |
Summary of findings |
||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| Participants (studies) follow-up | Risk of bias | Inconsistency | Indirectness | Imprecision | Publication bias | Overall certainty of evidence | Study event rates (%) |
Relative effect (95% CI) | Anticipated absolute effects |
||
| With [usual care] | With [CDSS] | Risk with [usual care] | Risk difference with [CDSS] | ||||||||
| All-cause mortality | |||||||||||
| 17,959 (8 RCTs) | Not serious | Not serious | Not serious | Not serious | None | ⊕⊕⊕⊕ High |
1253/8707 (14.4%) | 1322/9252 (14.3%) | RR 1.00 (0.93–1.07) | 144 per 1000 | 0 fewer per 1000 (from 10 fewer to 10 more) |
| Renal replacement therapy | |||||||||||
| 18,355 (9 RCTs) | Not serious | Not serious | Not serious | Not serious | None | ⊕⊕⊕⊕ High |
530/8903 (6.0%) | 609/9452 (6.4%) | RR 1.11 (0.99–1.24) | 60 per 1000 | 7 more per 1000 (from 1 fewer to 14 more) |
| Hyperkalemia | |||||||||||
| 1589 (3 RCTs) | Seriousa | Not serious | Not serious | Very seriousb | None | ⊕◯◯◯ Very low |
13/619 (2.1%) | 5/970 (0.5%) | RR 0.27 (0.10–0.73) | 21 per 1000 | 15 fewer per 1000 (from 19 fewer to 6 fewer) |
| eGFR | |||||||||||
| 2460 (3 RCTs) | Not serious | Not serious | Not serious | Seriousc | None | ⊕⊕⊕◯ Moderate |
1211 | 1249 | – | – | MD 1.97 higher (0.47 higher to 3.48 higher) |
| Re-hospitalization | |||||||||||
| 5307 (3 RCTs) | Not serious | Not serious | Not serious | Not serious | None | ⊕⊕⊕⊕ High |
385/2653 (14.5%) | 348/2654 (13.1%) | RR 0.90 (0.79–1.03) | 145 per 1000 | 15 fewer per 1000 (from 30 fewer to 4 more) |
| Creatinine | |||||||||||
| 4801 (3 RCTs) | Not serious | Not serious | Not serious | Not serious | None | ⊕⊕⊕⊕ High |
2377 | 2424 | – | – | MD 0 (0.04 lower to 0.04 higher) |
| AKI in discharge | |||||||||||
| 3335 (4 RCTs) | Seriousd | Very seriouse | Not serious | Seriousc | None | ⊕◯◯◯ Very low |
464/1619 (28.7%) | 770/1716 (44.9%) | RR 1.39 (0.94–2.05) | 287 per 1000 | 112 more per 1000 (from 17 fewer to 301 more) |
| Renal recovery | |||||||||||
| 3135 (3 RCTs) | Seriousf | Not serious | Not serious | Not serious | None | ⊕⊕⊕◯ Moderate |
790/1519 (52.0%) | 831/1616 (51.4%) | RR 0.99 (0.93–1.06) | 520 per 1000 | 5 fewer per 1000 (from 36 fewer to 31 more) |
| Progression of AKI | |||||||||||
| 14,439 (4 RCTs) | Not serious | Not serious | Not serious | Not serious | None | ⊕⊕⊕⊕ High |
1280/6981 (18.3%) | 1310/7458 (17.6%) | RR 0.98 (0.92–1.05) | 183 per 1000 | 4 fewer per 1000 (from 15 fewer to 9 more) |
| Length of hospital stay | |||||||||||
| 39,950 (6 RCTs) | Not serious | Very seriouse | Not serious | Not serious | None | ⊕⊕◯◯ Low |
21,918 | 18,032 | – | – | MD 0.22 lower (1.31 lower to 0.86 higher) |
| Hospital cost | |||||||||||
| 13,298 (3 RCTs) | Not serious | Not serious | Not serious | Extremely seriousc | None | ⊕◯◯◯ Very low |
6584 | 6714 | – | – | MD 826.46 higher (110.14 lower to 1763.06 higher) |
| Patients received NASIDs | |||||||||||
| 15,943 (6 RCTs) | Not serious | Seriousg | Not serious | Seriousc | None | ⊕⊕◯◯ Low |
1212/7902 (15.3%) | 1064/8041 (13.2%) | RR 0.81 (0.65–1.00) | 153 per 1000 | 29 fewer per 1000 (from 54 fewer to 0 fewer) |
| Patients received aminoglycosides | |||||||||||
| 10,631 (3 RCTs) | Not serious | Not serious | Not serious | Seriousc | None | ⊕⊕⊕◯ Moderate |
126/5248 (2.4%) | 99/5383 (1.8%) | RR 0.78 (0.60–1.00) | 24 per 1000 | 5 fewer per 1000 (from 10 fewer to 0 fewer) |
| Patients received ACEi and ARBs | |||||||||||
| 15,891 (5 RCTs) | Not serious | Not serious | Not serious | Not serious | None | ⊕⊕⊕⊕ High |
2148/7876 (27.3%) | 2187/8015 (27.3%) | RR 1.01 (0.96–1.06) | 273 per 1000 | 3 more per 1000 (from 11 fewer to 16 more) |
| Patients received contrast | |||||||||||
| 10,831 (4 RCTs) | Not serious | Not serious | Not serious | Not serious | None | ⊕⊕⊕⊕ High |
461/5348 (8.6%) | 474/5483 (8.6%) | RR 1.01 (0.91–1.13) | 86 per 1000 | 1 more per 1000 (from 8 fewer to 11 more) |
| Patients received fluid | |||||||||||
| 10,831 (4 RCTs) | Not serious | Very seriouse | Not serious | Seriousc | None | ⊕◯◯◯ Very low |
1524/5348 (28.5%) | 1839/5483 (33.5%) | RR 1.13 (0.95–1.36) | 285 per 1000 | 37 more per 1000 (from 14 fewer to 103 more) |
| Patients underwent renal ultrasound | |||||||||||
| 4653 (3 RCTs) | Not serious | Very seriouse | Not serious | Very seriousc | None | ⊕◯◯◯ Very low |
103/2303 (4.5%) | 165/2350 (7.0%) | RR 1.99 (0.69–5.78) | 45 per 1000 | 44 more per 1000 (from 14 fewer to 214 more) |
| Nephrologist consultation | |||||||||||
| 16,818 (7 RCTs) | Not serious | Seriousg | Not serious | Seriousc | None | ⊕⊕◯◯ Low |
1440/8310 (17.3%) | 1555/8508 (18.3%) | RR 1.13 (0.96–1.33) | 173 per 1000 | 23 more per 1000 (from 7 fewer to 57 more) |
CI: confidence interval; MD: mean difference; RR: risk ratio.
aThomas et al. had an overall concern of bias with 65% of pooled analysis weight.
bA wide confidence interval that does not exclude the risk of appreciable harm/benefit with a low number of events.
cA wide confidence interval that does not exclude the risk of appreciable harm/benefit.
dWu et al. had an overall concern of bias with 31.7% of pooled analysis weight.
eI2 > 75%.
fWu et al. had an overall concern of bias with 27% of pooled analysis weight.
gI2 > 50%.