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Nephron. 2019 Mar 21:1-10. doi: 10.1159/000499345. [Epub ahead of print]

A Clinical Score to Predict Severe Acute Kidney Injury in Chinese Patients after Cardiac Surgery.

Author information

1
Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
2
Department of Cardiovascular Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
3
Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China, drzhangweiming@126.com.
4
Hongqiao International Institute of Medicine, Shanghai Tongren Hospital and Clinical Research Institute, Shanghai Jiao Tong University School of Medicine, Shanghai, China.

Abstract

BACKGROUND/AIMS:

Cardiac surgery-associated severe acute kidney injury (SAKI) is associated with high mortality and poor quality of life. A prognostic score for SAKI may enable prevention of complications.

METHODS:

This observational study of 2,552 patients undergoing cardiac surgery from January 2006 to December 2011 in our institution established associations between predictor variables and postoperative SAKI from a cohort of 1,692 patients and developed a clinical score that was assessed in a validation cohort of 860 patients.

RESULTS:

Postoperative SAKI occurred in 262 -patients (10.3%). We identified 7 independent and significant risk factors in the derivation model (adjusted OR 95% CI): age ≥81 years (vs. age < 40 years, 4.30, 1.52-12.21), age 61-80 years (vs. age < 40 years, 2.84, 1.24-6.52), age 41-60 years (vs. age < 40 years, 1.62, 0.68-3.87), hypertension (1.65, 1.13-2.39), previous cardiac surgery (3.62, 1.27-10.32), -hyperuricemia (2.02, 1.40-2.92), prolonged operation time (1.32, 1.17-1.48), postoperative central venous pressure < 6 mm H2O (3.53, 2.38-5.23), and low postoperative cardiac output (4.78, 2.97-7.69). The 7-variable risk prediction model had acceptable performance characteristics in the validation cohort (C statistic 0.80, 95% CI 0.74-0.85). The difference in the C statistic was 0.21 (95% CI 0.12-0.29, p < 0.001) compared with the Cleveland Clinic score.

CONCLUSION:

We developed and validated a practical risk prediction model for SAKI after cardiac surgery based on routinely available perioperative clinical and laboratory data. The prediction model can be easily applied at the bedside and provides a simple and interpretable estimation of risk.

KEYWORDS:

Acute kidney injury; Cardiac surgery; Predictive model; Risk factor

PMID:
30897580
DOI:
10.1159/000499345

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