Dynamic Predictive Scores for Cardiac Surgery-Associated Acute Kidney Injury

作者：Jiang, Wuhua; Teng, Jie; Xu, Jiarui; Shen, Bo; Wang, Yimei; Fang, Yi; Zou, Zhouping; Jin, Jifu; Zhuang, Yamin; Liu, Lan; Luo, Zhe; Wang, Chunsheng; Ding, Xiaoqiang^*

来源：Journal of the American Heart Association, 2016, 5(8): e003754.

DOI：10.1161/JAHA.116.003754

• acute kidney injury
• cardiac surgery
• risk factor
• risk score

Background-Cardiac surgery-associated acute kidney injury (CSA-AKI) is a common complication with a poor prognosis. In order to identify modifiable perioperative risk factors for AKI, which existing risk scores are insufficient to predict, a dynamic clinical risk score to allow clinicians to estimate the risk of CSA-AKI from preoperative to early postoperative periods is needed. @@@ Methods and Results-A total of 7233 cardiac surgery patients in our institution from January 2010 to April 2013 were enrolled prospectively and distributed into 2 cohorts. Among the derivation cohort, logistic regression was used to analyze CSA-AKI risk factors preoperatively, on the day of ICU admittance and 24 hours after ICU admittance. Sex, age, valve surgery combined with coronary artery bypass grafting, preoperative NYHA score >2, previous cardiac surgery, preoperative kidney (without renal replacement therapy) disease, intraoperative cardiopulmonary bypass application, intraoperative erythrocyte transfusions, and postoperative low cardiac output syndrome were identified to be associated with CSA-AKI. Among the other 1152 patients who served as a validation cohort, the point scoring of risk factor combinations led to area under receiver operator characteristics curves (AUROC) values for CSA-AKI prediction of 0.74 (preoperative), 0.75 (on the day of ICU admission), and 0.82 (postoperative), and Hosmer-Lemeshow goodness-of-fit tests revealed a good agreement of expected and observed CSA-AKI rates. @@@ Conclusions-The first dynamic predictive score system, with Kidney Disease: Improving Global Outcomes (KDIGO) AKI definition, was developed and predictive efficiency for CSA-AKI was validated in cardiac surgery patients.

• 出版日期2016-8
• 单位复旦大学