Limits...
Dynamic Predictive Scores for Cardiac Surgery – Associated Acute Kidney Injury

View Article: PubMed Central - PubMed

ABSTRACT

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.

No MeSH data available.


ROC curves for predicting CSA‐AKI in the validation cohort with point scores from Table 5. *Application of the scoring system led to AUC values of 0.74 (preoperative), 0.75 (at ICU admission), and 0.82 (postoperative).
© Copyright Policy - creativeCommonsBy-nc
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC5015294&req=5

jah31676-fig-0001: ROC curves for predicting CSA‐AKI in the validation cohort with point scores from Table 5. *Application of the scoring system led to AUC values of 0.74 (preoperative), 0.75 (at ICU admission), and 0.82 (postoperative).

Mentions: The clinical characteristics of the 1152 patients in the validation cohort are shown in Table 1. Application of the scoring system led to AUC values of 0.74 (preoperative), 0.75 (at ICU admission), and 0.82 (postoperative) (Figure 1). The calibration of the scores is shown in Figure 2. There was no statistically significant difference between the predicted and observed CSA‐AKI incidences in the validation cohort (preoperative χ2=6.346, P=0.175; at the day of ICU admittance χ2=4.65, P=0.703; and postoperative χ2=3.669, P=0.886).


Dynamic Predictive Scores for Cardiac Surgery – Associated Acute Kidney Injury
ROC curves for predicting CSA‐AKI in the validation cohort with point scores from Table 5. *Application of the scoring system led to AUC values of 0.74 (preoperative), 0.75 (at ICU admission), and 0.82 (postoperative).
© Copyright Policy - creativeCommonsBy-nc
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5015294&req=5

jah31676-fig-0001: ROC curves for predicting CSA‐AKI in the validation cohort with point scores from Table 5. *Application of the scoring system led to AUC values of 0.74 (preoperative), 0.75 (at ICU admission), and 0.82 (postoperative).
Mentions: The clinical characteristics of the 1152 patients in the validation cohort are shown in Table 1. Application of the scoring system led to AUC values of 0.74 (preoperative), 0.75 (at ICU admission), and 0.82 (postoperative) (Figure 1). The calibration of the scores is shown in Figure 2. There was no statistically significant difference between the predicted and observed CSA‐AKI incidences in the validation cohort (preoperative χ2=6.346, P=0.175; at the day of ICU admittance χ2=4.65, P=0.703; and postoperative χ2=3.669, P=0.886).

View Article: PubMed Central - PubMed

ABSTRACT

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.

No MeSH data available.