Abstract
Abstract
At present, several scores have been developed to assess the risk of acute kidney injury (AKI) after cardiac surgery, and every score represents a compromise between the completeness of the factors and the early evaluation of the AKI risk. This study examined whether the predictive reliability of an AKI risk score can be significantly improved by applying not only preoperative risk factors but also intraoperative and postoperative parameters for the calculation of the score.
Materials and methods
Three scores were deduced from the data of 662 patients undergoing cardiac surgery; these were based on preoperative (score 1), pre- and intraoperative (score 2) or on pre-, intra- and postoperative parameters (score 3). Sensitivity and specificity for the prediction of an AKI were determined from a validation population comprising 529 additional patients.
Results
AKI occurred in 455 patients (38.2%). Sensitivity and specificity of the scores were 60.9% and 67.6% (score 1), 60.4% and 68.2% (score 2) and 66.8% and 64.8% (score 3).
Conclusion
The inclusion of intra- and postoperative parameters into a predictive model does not significantly improve the ability to identify patients at risk of AKI. As scores based on preoperative parameters allow for the earliest possible risk stratification, they should be preferred in clinical practice.
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References
Bove T., Calabro M.G., Landoni G., Aletti G., Marino G., Crescenzi G., et al., The incidence and risk of acute renal failure after cardiac surgery, J Cardiothorac Vasc Anesth, 2004, 18, 442–445
Provenchere S., Plantefeve G., Hufnagel G., Vicaut E., De Vaumas C., Lecharny J. B., et al., Renal dysfunction after cardiac surgery with normothermic cardiopulmonary bypass: incidence, risk factors, and effect on clinical outcome, Anesth Analg, 2003, 96, 1258–1264, table of contents
Bellomo R., Ronco C., Kellum J. A., Mehta R. L. Palevsky P., Acute renal failure-definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group, Crit Care, 2004, 8, R204–212
Mehta R. L., Kellum J. A., Shah S. V., Molitoris B. A., Ronco C., Warnock D. G., et al., Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury, Crit Care, 2007, 11, R31
Park M., Coca S. G., Nigwekar S. U., Garg A. X., Garwood S. Parikh C. R., Prevention and treatment of acute kidney injury in patients undergoing cardiac surgery: a systematic review, Am J Nephrol, 2010, 31, 408–418
Brown J. R., Cochran R. P., Leavitt B. J., Dacey L. J., Ross C. S., MacKenzie T. A., et al., Multivariable prediction of renal insufficiency developing after cardiac surgery, Circulation, 2007, 116, I139–243
Mehta R. H., Grab J. D., O’Brien S. M., Bridges C. R., Gammie J. S., Haan C. K., et al., Bedside tool for predicting the risk of postoperative dialysis in patients undergoing cardiac surgery, Circulation, 2006, 114, 2208–2216; quiz 2208
Palomba H., de Castro I., Neto A. L., Lage S. Yu L., Acute kidney injury prediction following elective cardiac surgery: AKICS Score, Kidney Int, 2007, 72, 624–631
Thakar C. V., Arrigain S., Worley S., Yared J. P. Paganini E. P., A clinical score to predict acute renal failure after cardiac surgery, J Am Soc Nephrol, 2005, 16, 162–168
Wijeysundera D. N., Karkouti K., Dupuis J. Y., Rao V., Chan C. T., Granton J. T., et al., Derivation and validation of a simplified predictive index for renal replacement therapy after cardiac surgery, Jama, 2007, 297, 1801–1809
Toll D. B., Janssen K. J., Vergouwe Y. Moons K. G., Validation, updating and impact of clinical prediction rules: a review, J Clin Epidemiol, 2008, 61, 1085–1094
Chertow G. M., Burdick E., Honour M., Bonventre J. V. Bates D. W., Acute kidney injury, mortality, length of stay, and costs in hospitalized patients, J Am Soc Nephrol, 2005, 16, 3365–3370
Dasta J. F., Kane-Gill S. L., Durtschi A. J., Pathak D. S. Kellum J. A., Costs and outcomes of acute kidney injury (AKI) following cardiac surgery, Nephrol Dial Transplant, 2008, 23, 1970–1974
Vandijck D. M., Oeyen S., Decruyenaere J. M., Annemans L. Hoste E. A., Acute kidney injury, length of stay, and costs in patients hospitalized in the intensive care unit, Acta Clin Belg Suppl, 2007, 341–345
Stallwood M. I., Grayson A. D., Mills K. Scawn N. D., Acute renal failure in coronary artery bypass surgery: independent effect of cardiopulmonary bypass, Ann Thorac Surg, 2004, 77, 968–972
Taniguchi F. P., de Souza A. R. Martins A. S., Cardiopulmonary bypass time as a risk factor for acute renal failure, Rev Bras Cir Cardiovasc, 2007, 22, 201–205
Karkouti K., Beattie W. S., Wijeysundera D. N., Rao V., Chan C., Dattilo K. M., et al., Hemodilution during cardiopulmonary bypass is an independent risk factor for acute renal failure in adult cardiac surgery, J Thorac Cardiovasc Surg, 2005, 129, 391–400
Ranucci M., Romitti F., Isgro G., Cotza M., Brozzi S., Boncilli A., et al., Oxygen delivery during cardiopulmonary bypass and acute renal failure after coronary operations, Ann Thorac Surg, 2005, 80, 2213–2220
Fischer U. M., Weissenberger W. K., Warters R. D., Geissler H. J., Allen S. J. Mehlhorn U., Impact of cardiopulmonary bypass management on postcardiac surgery renal function, Perfusion, 2002, 17, 401–406
Fieghen H., Wald R. Jaber B. L., Renal replacement therapy for acute kidney injury, Nephron Clin Pract, 2009, 112, c222–229
Gibney R. T., Bagshaw S. M., Kutsogiannis D. J. Johnston C., When should renal replacement therapy for acute kidney injury be initiated and discontinued?, Blood Purif, 2008, 26, 473–484
Macedo E. Mehta R. L., Prerenal failure: from old concepts to new paradigms, Curr Opin Crit Care, 2009, 15, 467–473
Zappitelli M., Bernier P. L., Saczkowski R. S., Tchervenkov C. I., Gottesman R., Dancea A., et al., A small post-operative rise in serum creatinine predicts acute kidney injury in children undergoing cardiac surgery, Kidney Int, 2009, 76, 885–892
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Heise, D., Kunze, N., Bürger, J. et al. Modifying a kidney injury score by including perioperative data Comparison of three predictive scores. cent.eur.j.med 7, 420–428 (2012). https://doi.org/10.2478/s11536-011-0170-6
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DOI: https://doi.org/10.2478/s11536-011-0170-6