Objectives
This study was performed to internally derive and then validate risk score systems
using preoperative and intraoperative variables to predict the occurrence of any-stage
(stage 1, 2, 3) and stage-3 acute kidney injury (AKI) within seven days of cardiac
surgery.
Design
Single-center, retrospective, observational study.
Setting
Single, large, tertiary care center.
Participants
Adult patients undergoing open cardiac surgery between January 1, 2012, and January
1, 2019.
Measurements and Main Results
The clinical data were divided into the following two groups: a derivation cohort
(n = 43,799) and a validation cohort (n = 14,600). AKI was defined using the Kidney
Disease: Improving Global Outcomes criteria. Multivariate logistic regression analysis
was used to develop the prediction models. The overall prevalence of any-stage AKI
and stage-3 AKI after cardiac surgery were 34.3% and 1.7%, respectively. The discriminatory
ability of the any-stage AKI prediction model measured with the area under the curve
(AUC) was acceptable (AUC = 0.69, 95% confidence interval 0.68-0.69), and the calibration
measured with the Hosmer-Lemeshow test was good (p = 0.95). The AUC for the stage-3
AKI prediction model was 0.84 (95% confidence interval 0.83-0.85), and the Hosmer-Lemeshow
test also indicated a good calibration (p = 0.73).
Conclusions
This research study, which used preoperative and intraoperative variables, derived
and internally validated two predictive scoring systems for any-stage AKI and stage-3
AKI as defined by modified Kidney Disease: Improving Global Outcomes criteria using
a very large cohort of Chinese cardiac surgical patients.
Graphical Abstract
Graphical Abstract
Key Words
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References
- Acute and chronic kidney disease and cardiovascular mortality after major surgery.Ann Surg. 2016; 264: 987-996
- Cardiovascular-specific mortality and kidney disease in patients undergoing vascular surgery.JAMA Surg. 2016; 151: 441-450
- Cost and mortality associated with postoperative acute kidney injury.Ann Surg. 2015; 261: 1207-1214
- Preoperative proteinuria predicts adverse renal outcomes after coronary artery bypass grafting.J Am Soc Nephrol. 2011; 22: 156-163
- Predicting acute kidney injury after cardiac surgery: A systematic review.Ann Thorac Surg. 2012; 93: 337-347
- Arterial stiffness is a predictor for acute kidney injury following coronary artery bypass graft surgery.J Cardiothorac Surg. 2019; 14: 51
- Postoperative acute kidney injury following intraoperative blood product transfusions during cardiac surgery.Perfusion. 2018; 33: 62-70
- Influence of acute kidney injury on short- and long-term outcomes in patients undergoing cardiac surgery: Risk factors and prognostic value of a modified RIFLE classification.Crit Care. 2013; 17: R293
- Transparent reporting of a multivariable prediction model for individual prognosis or diagnosis (TRIPOD): The TRIPOD statement.BMJ. 2015; 350: g7594
- Acute renal failure: An unacceptable death sentence globally.Lancet. 2013; 382: 2041-2042
- Diagnosis, evaluation, and management of acute kidney injury: A KDIGO summary (part 1).Crit Care. 2013; 17: 204
- A clinical score to predict acute renal failure after cardiac surgery.J Am Soc Nephrol. 2005; 16: 162-168
- Bedside tool for predicting the risk of postoperative dialysis in patients undergoing cardiac surgery.Circulation. 2006; 114: 2208-2216
- Acute kidney injury prediction following elective cardiac surgery: AKICS score.Kidney Int. 2007; 72: 624-631
- How can we best predict acute kidney injury following cardiac surgery? A prospective observational study.Eur J Anaesthesiol. 2013; 30: 704-712
- Predictive models for Kidney Disease: Improving Global Outcomes (KDIGO) defined acute kidney injury in UK cardiac surgery.Crit Care. 2014; 18: 606
- Prediction of acute kidney injury within 30 days of cardiac surgery.J Thorac Cardiovasc Surg. 2014; 147: 1875-1883
- Dynamic predictive scores for cardiac surgery-associated acute kidney injury.J Am Heart Assoc. 2016; 5e003754
- A new model to predict acute kidney injury requiring renal replacement therapy after cardiac surgery.Can Med Assoc J. 2016; 188: 1076-1083
- Evaluation and management of chronic kidney disease: Synopsis of the Kidney Disease: Improving Global Outcomes 2012 clinical practice guideline.Ann Intern Med. 2013; 158: 825-830
- Applicability of theCleveland Clinic scoring system for the risk prediction of acute kidney injury after cardiac surgery in a South Asian cohort.Indian Heart J. 2018; 70: 533-537
- Validation of renal-risk models for the prediction of non-renal replacement therapy cardiac surgery-associated acute kidney injury.Int J Cardiol. 2018; 272: 49-53
- Validation of four prediction scores for cardiac surgery-associated acute kidney injury in Chinese patients.Braz J Cardiovasc Surg. 2017; 32: 481-486
- Association of ethnicity and acute kidney injury after cardiac surgery in a South East Asian population.Br J Anaesth. 2013; 110: 397-401
- A clinical score to predict severe acute kidney injury in Chinese patients after cardiac surgery.Nephron. 2019; 142: 291-300
- A clinical score to predict acute kidney injury after cardiac surgery in a Southeast-Asian population.Interact Cardiovasc Thorac Surg. 2016; 23: 757-761
- Predicting cardiac surgery-associated acute kidney injury: The CRATE score.J Crit Care. 2016; 31: 130-138
Article info
Publication history
Published online: February 22, 2021
Footnotes
This study was supported by the nonprofit Central Research Institute Fund of Chinese Academy of Medical Sciences (2019XK320052).
Identification
Copyright
© 2021 Elsevier Inc. All rights reserved.
