Fix KDIGO Stage 3 hardcoded 3.7 threshold in creatinine check#1987
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Chessing234 wants to merge 1 commit intoMIT-LCP:mainfrom
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Fix KDIGO Stage 3 hardcoded 3.7 threshold in creatinine check#1987Chessing234 wants to merge 1 commit intoMIT-LCP:mainfrom
Chessing234 wants to merge 1 commit intoMIT-LCP:mainfrom
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…heck The 48-hour acute rise criterion compared creat_low_past_48hr against the hardcoded value 3.7 (i.e. 4.0 - 0.3), which is only correct when creatinine equals exactly 4.0. Replace with the dynamic expression cr.creat >= (cr.creat_low_past_48hr + 0.3) to correctly evaluate the >=0.3 acute increase for any creatinine value >=4.0. Fixes MIT-LCP#1357
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Bug
The KDIGO AKI Stage 3 criterion for sCr >= 4.0 mg/dL requires evidence of an acute rise: either >= 0.3 mg/dL increase within 48 hours, or >= 1.5x the 7-day baseline. The 48-hour check uses the hardcoded expression
creat_low_past_48hr <= 3.7(i.e.,4.0 - 0.3), which is only correct when the current creatinine equals exactly 4.0.For any creatinine above 4.0, this misclassifies patients. For example, a patient with creatinine = 5.0 and 48h-low = 3.9 has a 1.1 mg/dL acute rise but
3.9 <= 3.7evaluates to FALSE, potentially missing the Stage 3 classification.Root cause
The hardcoded
3.7in the Stage 3 branch ofkdigo_stages.sqlassumes creatinine is always exactly 4.0 at the threshold, rather than using the actual current creatinine value dynamically.Fix
Replace
cr.creat_low_past_48hr <= 3.7withcr.creat >= (cr.creat_low_past_48hr + 0.3), which correctly evaluates the >= 0.3 acute increase criterion for any creatinine value. This matches the pattern already used for Stage 1 (cr.creat >= (cr.creat_low_past_48hr + 0.3)).Fixed in both canonical source files (mimic-iii/concepts and mimic-iv/concepts). The auto-generated postgres/duckdb variants would need regeneration.
Closes #1357