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J Crit Care. 2016 Feb;31(1):130-8. doi: 10.1016/j.jcrc.2015.11.004. Epub 2015 Nov 6.

Predicting cardiac surgery-associated acute kidney injury: The CRATE score.

Author information

1
Department of Anesthesiology and Reanimation, Hospital Clinico Universitario de Valladolid, Valladolid, Spain.
2
Department of Cardiovascular Surgery, Hospital Universitario de La Princesa, Madrid, Spain. Electronic address: jbustamantemunguira@gmail.com.
3
Department of Anesthesiology and Reanimation, Hospital Clinico Universitario de Valladolid, Valladolid, Spain; Immunity, Risk of Infection and Sepsis group (IRIS), Hospital Clínico Universitario de Valladolid, Valladolid, Spain.
4
Department of Pharmacology and Therapeutics, Valladolid University Physicians College, Valladolid, Spain.
5
Immunity, Risk of Infection and Sepsis group (IRIS), Hospital Clínico Universitario de Valladolid, Valladolid, Spain; Infection & Immunity Medical Investigation group, Hospital Clínico Universitario-IECSCYL, Valladolid, Spain.

Abstract

PURPOSE:

Acute kidney injury (AKI) is a frequent complication after cardiac surgery and is associated with increased mortality. The aim was to design a nondialytic AKI score in patients with previously normal renal function undergoing cardiac surgery.

METHODS:

Data were collected on 909 patients who underwent cardiac surgery with cardiopulmonary bypass between 2012 and 2014. A total of 810 patients fulfilled the inclusion criteria. Patients were classified as having AKI based on the RIFLE criteria. Postoperative AKI occurred in 137 patients (16.9%). Several parameters were recorded preoperatively, intraoperatively, and at intensive care unit admission, looking for a univariate and multivariate association with AKI risk. A second data set of 741 patients, from 2 different hospitals, was recorded as a validation cohort.

RESULTS:

Four independent risk factors were included in the CRATE score: creatinine (odds ratio [OR], 9.66; 95% confidence interval [CI], 4.77-19.56; P < .001), EuroSCORE (OR, 1.40; CI, 1.29-1.52; P < .001), lactate (OR, 1.03; CI, 1.01-1.04; P < .001), and cardiopulmonary bypass time (OR, 1.01; CI, 1.01-1.02; P < .001). The accuracy of the model was good, with an area under the curve of 0.89 (CI, 0.85-0.92). The CRATE score retained good discrimination in validation cohort, with an area under the curve of 0.81 (95% CI, 0.78-0.85).

CONCLUSIONS:

CRATE score is an accurate and easy to calculate risk score that uses affordable and widely available variables in the routine care surgical patients.

KEYWORDS:

Cardiac surgery; Renal insufficiency; Risk prediction; Risk score

PMID:
26700607
DOI:
10.1016/j.jcrc.2015.11.004
[Indexed for MEDLINE]

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