Clinical Predictive Score for Acute Kidney Injury after Cardiac Surgery in Adults_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

YE Nan , ZHANG Yan , CHENG Hong , CHEN Yipu.

Division of Nephrology，Beijing Anzhen Hospital，Capital Medical University，Beijing 100029，P. R. China;

Corresponding author：

Keywords：

Cardiac surgery; Acute kidney injury; Risk factor; Predictive score system

DOI：

10.7507/1007-4848.20130125

Video：

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Objective To analyze risk factors of acute kidney injury （AKI） after cardiac surgery in adults and develop　a clinical score system to predict postoperative AKI. Methods Clinical data of 3 500 consecutive patients undergoing　cardiac surgery from June 2010 to April 2011 in Beijing Anzhen Hospital of Capital Medical University were retrospectively　analyzed. According to whether they had postoperative AKI，all these patients were divided into AKI group and non-AKI group. AKI group was consisted of 1 407 patients （40.2%） with a mean age of 58±12 years，including 1 004 male patients （71.4%）. The non-AKI group was consisted of 2 093 patients （59.8%） with a mean age of 55±13 years，including 1 259 male patients （60.2%）. Predictive score system of postoperative AKI was established by univariate analysis between the AKI　and non-AKI group and multivariate logistic regression and then verified. Results The predictive score system was as followed：male gender （2 points），every 5 years older than 60 years （1 point），diabetes mellitus （2 points），preoperative use　of angiotensin converting enzyme inhibitor or angiotensin AT1 receptor blocker （1 point），every 10 ml / （min·1.73 m2） of preoperative estimated glomerular filtration rate （eGFR） under 90 ml / （min·1.73m2）（1 point），preoperative NYHA class Ⅳ （3 points），cardiopulmonary bypass time＞120 minutes （2 points），intraoperative hypotension duration＞60 minutes （2 points），postoperative hypotension duration＞60 minutes （3 points），postoperative peak dosage of intravenous furosemide＞100 mg/day （3 points），postoperative peak dosage of intravenous furosemide 60-100 mg/day （2 points），and postoperative mechanical ventilation time＞24 hours （2 points）. The predictive score system presented a good discrimination ability with the area under the receiver operating characteristic（ROC）curve of 0.738 with 95% CI 0.707 to 0.768，while it also presented a good calibration with Hosmer-Lemeshow statistic （P=0.305）. Conclusion A clinical predictive score system for AKI after cardiac surgery in adults is established，which may help clinicians implement early preventive　interventions.

Citation： YE Nan,ZHANG Yan,CHENG Hong,CHEN Yipu.. Clinical Predictive Score for Acute Kidney Injury after Cardiac Surgery in Adults. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2013, 20(4): 396-401. doi: 10.7507/1007-4848.20130125 Copy

1.	Palomba H， de Castro I， Neto AL， et al. Acute kidney injuryprediction following elective cardiac surgery：AKICS Score. Kidney Int， 2007， 72 （5）：624-631.
2.	Englberger L， Suri RM， Li Z， et al. Clinical accuracy of RIFLE and Acute Kidney Injury Network （AKIN） criteria for acute kidneyinjury in patients undergoing cardiac surgery. Crit Care， 2011， 15 （1）：R16.
3.	Che M， Li Y， Liang X， et al. Prevalence of acute kidney injury following cardiac surgery and related risk factors in Chinese patients. Nephron Clin Pract， 2011， 117 （4）：c305-c311.
4.	Chertow GM， Lazarus JM， Christiansen CL， et al. Preoperative renal risk stratification. Circulation， 1997， 95 （4）：878-884.5 Thakar CV， Arrigain S， Worley S， et al. A clinical score to predict acute renal failure after cardiac surgery. J Am Soc Nephrol， 2005， 16 （1）：162-168.
5.	Mehta RH， Grab JD， O′brien SM， et al. Bedside tool for predictingthe risk of postoperative dialysis in patients undergoing cardiacsurgery. Circulation， 2006， 114 （21）：2208-2216.
6.	Wijeysundera DN， Karkouti K， Dupuis JY， et al. Derivation and validation of a simplified predictive index for renal replacement therapy after cardiac surgery. JAMA， 2007， 297 （16）：1801-1809.
7.	Hobson CE， Yavas S， Segal MS， et al. Acute kidney injury is associated with increased long-term mortality after cardiothoracic surgery. Circulation， 2009， 119 （18）：2444-2453.
8.	Jyrala A， Weiss RE， Jeffries RA， et al. Effect of mild renal dysfun-ction （s-crea 1.2-2.2 mg/dl） on presentation characteristics and short- andlong-term outcomes of on-pump cardiac surgery patients. Interact Cardiovasc Thorac Surg， 2010， 10 （5）：777-782.
9.	Thakar CV， Worley S， Arrigain S， et al. Improved survival in acute kidney injury after cardiac surgery. Am J Kidney Dis， 2007， 50 （5）：703-711.
10.	Lassnigg A， Schmidlin D， Mouhieddine M， et al. Minimal changes of serum creatinine predict prognosis in patients after cardiothoracic surgery：a prospective cohort study. J Am Soc Nephrol， 2004， 15 （6）：1597-1605.
11.	Kilo J， Margreiter JE， Ruttmann E， et al. Slightly elevated serum creatinine predicts renal failure requiring hemofiltration after cardiac surgery. Heart Surg Forum， 2005， 8 （1）：E34-E38.
12.	全国eGFR课题协作组. MDRD方程在我国慢性肾脏病患者中的改良和评估. 中华肾脏病杂志， 2006， 22 （10）：589-595.
13.	Mehta RL， Kellum JA， Shah SV， et al. Acute kidney injury network：report of an initiative to improve outcomes in acute kidney injury. Crit Care， 2007， 11 （2）：R31.
14.	Karkouti K， Wijeysundera DN， Yau TM， et al. Acute kidney injury after cardiac surgery：focus on modifiable risk factors. Circulation， 2009， 119 （4）：495-502.
15.	Rahmanian PB， Filsoufi F， Castillo JG， et al. Predicting postoperativerenal failure requiring dialysis， and an analysis of long-term outcome in patients undergoing valve surgery. J Heart Valve Dis， 2008， 17 （6）：657-665.
16.	Thakar CV， Liangos O， Yared JP， et al. ARF after open-heartsurgery：Influence of gender and race. Am J Kidney Dis， 2003， 41 （4）：742-751.
17.	Villablanca AC， Jayachandran M， Banka C. Atherosclerosis and sex hormones：current concepts. Clin Sci （Lond）， 2010， 119 （12）：493-513.
18.	Schmekal BC， prognosis of nontraumatic acute renal failure requiringdialysis in adult patients with， without D. Ren fail， 2004， 26 （1）：39-43.
19.	Rahmanian PB， Kwiecien G， Langebartels G， et al. Logistic risk model predicting postoperative renal failure requiring dialysis incardiac surgery patients. Eur J Cardiothorac Surg， 2011， 40 （3）：701-707.
20.	Boldt J， Brenner T， Lehmann A， et al. Is kidney function altered by the duration of cardiopulmonary bypass? Ann Thorac Surg， 2003， 75 （3）：906-912.
21.	Arora P， Rajagopalam S， Ranjan R， et al. Preoperative use of angiotensin-converting enzyme inhibitors/angiotensin receptor blockersis associated with increased risk for acute kidney injury after cardiovascular surgery. Clin J Am Soc Nephrol， 2008， 3 （5）：1266-1273.
22.	Mahesh B， Yim B， Robson D， et al. Does furosemide prevent renal dysfunction in high-risk cardiac surgical patients ? Results of a double-blinded prospective randomised trial. Eur J Cardiothorac Surg， 2008， 33 （3）：370-376.

1. 　Palomba H， de Castro I， Neto AL， et al. Acute kidney injuryprediction following elective cardiac surgery：AKICS Score. Kidney Int， 2007， 72 （5）：624-631.
2. 　Englberger L， Suri RM， Li Z， et al. Clinical accuracy of RIFLE and Acute Kidney Injury Network （AKIN） criteria for acute kidneyinjury in patients undergoing cardiac surgery. Crit Care， 2011， 15 （1）：R16.
3. 　Che M， Li Y， Liang X， et al. Prevalence of acute kidney injury following cardiac surgery and related risk factors in Chinese patients. Nephron Clin Pract， 2011， 117 （4）：c305-c311.
4. 　Chertow GM， Lazarus JM， Christiansen CL， et al. Preoperative renal risk stratification. Circulation， 1997， 95 （4）：878-884.5 Thakar CV， Arrigain S， Worley S， et al. A clinical score to predict acute renal failure after cardiac surgery. J Am Soc Nephrol， 2005， 16 （1）：162-168.
5. 　Mehta RH， Grab JD， O′brien SM， et al. Bedside tool for predictingthe risk of postoperative dialysis in patients undergoing cardiacsurgery. Circulation， 2006， 114 （21）：2208-2216.
6. 　Wijeysundera DN， Karkouti K， Dupuis JY， et al. Derivation and validation of a simplified predictive index for renal replacement therapy after cardiac surgery. JAMA， 2007， 297 （16）：1801-1809.
7. 　Hobson CE， Yavas S， Segal MS， et al. Acute kidney injury is associated with increased long-term mortality after cardiothoracic surgery. Circulation， 2009， 119 （18）：2444-2453.
8. 　Jyrala A， Weiss RE， Jeffries RA， et al. Effect of mild renal dysfun-ction （s-crea 1.2-2.2 mg/dl） on presentation characteristics and short- andlong-term outcomes of on-pump cardiac surgery patients. Interact Cardiovasc Thorac Surg， 2010， 10 （5）：777-782.
9. 　Thakar CV， Worley S， Arrigain S， et al. Improved survival in acute kidney injury after cardiac surgery. Am J Kidney Dis， 2007， 50 （5）：703-711.
10. 　Lassnigg A， Schmidlin D， Mouhieddine M， et al. Minimal changes of serum creatinine predict prognosis in patients after cardiothoracic surgery：a prospective cohort study. J Am Soc Nephrol， 2004， 15 （6）：1597-1605.
11. 　Kilo J， Margreiter JE， Ruttmann E， et al. Slightly elevated serum creatinine predicts renal failure requiring hemofiltration after cardiac surgery. Heart Surg Forum， 2005， 8 （1）：E34-E38.
12. 　全国eGFR课题协作组. MDRD方程在我国慢性肾脏病患者中的改良和评估. 中华肾脏病杂志， 2006， 22 （10）：589-595.
13. 　Mehta RL， Kellum JA， Shah SV， et al. Acute kidney injury network：report of an initiative to improve outcomes in acute kidney injury. Crit Care， 2007， 11 （2）：R31.
14. 　Karkouti K， Wijeysundera DN， Yau TM， et al. Acute kidney injury after cardiac surgery：focus on modifiable risk factors. Circulation， 2009， 119 （4）：495-502.
15. 　Rahmanian PB， Filsoufi F， Castillo JG， et al. Predicting postoperativerenal failure requiring dialysis， and an analysis of long-term outcome in patients undergoing valve surgery. J Heart Valve Dis， 2008， 17 （6）：657-665.
16. 　Thakar CV， Liangos O， Yared JP， et al. ARF after open-heartsurgery：Influence of gender and race. Am J Kidney Dis， 2003， 41 （4）：742-751.
17. 　Villablanca AC， Jayachandran M， Banka C. Atherosclerosis and sex hormones：current concepts. Clin Sci （Lond）， 2010， 119 （12）：493-513.
18. 　Schmekal BC， prognosis of nontraumatic acute renal failure requiringdialysis in adult patients with， without D. Ren fail， 2004， 26 （1）：39-43.
19. 　Rahmanian PB， Kwiecien G， Langebartels G， et al. Logistic risk model predicting postoperative renal failure requiring dialysis incardiac surgery patients. Eur J Cardiothorac Surg， 2011， 40 （3）：701-707.
20. 　Boldt J， Brenner T， Lehmann A， et al. Is kidney function altered by the duration of cardiopulmonary bypass? Ann Thorac Surg， 2003， 75 （3）：906-912.
21. 　Arora P， Rajagopalam S， Ranjan R， et al. Preoperative use of angiotensin-converting enzyme inhibitors/angiotensin receptor blockersis associated with increased risk for acute kidney injury after cardiovascular surgery. Clin J Am Soc Nephrol， 2008， 3 （5）：1266-1273.
22. 　Mahesh B， Yim B， Robson D， et al. Does furosemide prevent renal dysfunction in high-risk cardiac surgical patients ? Results of a double-blinded prospective randomised trial. Eur J Cardiothorac Surg， 2008， 33 （3）：370-376.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Clinical Predictive Score for Acute Kidney Injury after Cardiac Surgery in Adults

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