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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.


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Subgroup analysis between categorized age groups for CSA‐AKI incidence. *The CSA‐AKI incidence was statistically significantly different within the subgroups, and increased with age. CSA‐AKI indicates cardiac surgery–associated acute kidney injury.
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jah31676-fig-0003: Subgroup analysis between categorized age groups for CSA‐AKI incidence. *The CSA‐AKI incidence was statistically significantly different within the subgroups, and increased with age. CSA‐AKI indicates cardiac surgery–associated acute kidney injury.

Mentions: Male sex and age were risk factors for CSA‐AKI in all 3 time points, and with increasing age, the incidence of CSA‐AKI also increased. Age‐associated AKI was reported to occur more frequently in the elderly due to structural changes such as vascular sclerosis, increased percentages of sclerosing glomeruli, and other degenerative changes that occur with increasing age,18, 19 and our finding is in agreement with other publications from Fang et al,20, 21 who noted that the incidence of CSA‐AKI in the older patients was higher than that in younger patients. In our cohort we conducted a subgroup analysis according to the categorized age and found significant differences in CSA‐AKI incidence between groups (Figure 3). The risk factor of male sex is in disagreement with other publications in which female sex was a risk factor,22, 23 which needs further analysis.


Dynamic Predictive Scores for Cardiac Surgery – Associated Acute Kidney Injury
Subgroup analysis between categorized age groups for CSA‐AKI incidence. *The CSA‐AKI incidence was statistically significantly different within the subgroups, and increased with age. CSA‐AKI indicates cardiac surgery–associated acute kidney injury.
© Copyright Policy - creativeCommonsBy-nc
Related In: Results  -  Collection

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

jah31676-fig-0003: Subgroup analysis between categorized age groups for CSA‐AKI incidence. *The CSA‐AKI incidence was statistically significantly different within the subgroups, and increased with age. CSA‐AKI indicates cardiac surgery–associated acute kidney injury.
Mentions: Male sex and age were risk factors for CSA‐AKI in all 3 time points, and with increasing age, the incidence of CSA‐AKI also increased. Age‐associated AKI was reported to occur more frequently in the elderly due to structural changes such as vascular sclerosis, increased percentages of sclerosing glomeruli, and other degenerative changes that occur with increasing age,18, 19 and our finding is in agreement with other publications from Fang et al,20, 21 who noted that the incidence of CSA‐AKI in the older patients was higher than that in younger patients. In our cohort we conducted a subgroup analysis according to the categorized age and found significant differences in CSA‐AKI incidence between groups (Figure 3). The risk factor of male sex is in disagreement with other publications in which female sex was a risk factor,22, 23 which needs further analysis.

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.


Related in: MedlinePlus