Serum creatinine measurement immediately after cardiac surgery and prediction of acute kidney injury.

After heart surgery, acute kidney injury (AKI) confers substantial long-term risk of death and chronic kidney disease. We hypothesized that small changes in serum creatinine (SCr) levels measured within a few hours of exit from the operating room could help discriminate those at low versus high risk of AKI. Prospective cohort of 350 elective cardiac surgery patients (valve or coronary artery bypass grafting) recruited in Winnipeg, Canada. Baseline SCr level was obtained at the preoperative visit 2 weeks before surgery. The postoperative SCr level was drawn within 6 hours of completion of surgery and then daily while the patient was in the hospital. Immediate (ie, <6 hours) postoperative SCr level change (ΔSCr), categorized as within 10% (reference), decrease >10%, or increase >10% relative to baseline. AKI, defined according to the new KDIGO (Kidney Disease: Improving Global Outcomes) consensus definition as an increase in SCr level >0.3 mg/dL within 48 hours or >1.5 times baseline within 1 week. We compared the C statistic of logistic models with and without inclusion of immediate postoperative ΔSCr. After surgery, 176 patients (52%) experienced a decrease >10% in SCr level, 26 (7.4%) experienced an increase >10%, and 143 had ΔSCr within ±10% of baseline. During hospitalization, 53 (14%) developed AKI. Bypass pump time, baseline estimated glomerular filtration rate, and European System for Cardiac Operative Risk Evaluation (euroSCORE) were associated with AKI in a parsimonious base logistic model. Added to the base model, immediate postoperative ΔSCr was associated strongly with subsequent AKI and significantly improved model discrimination over the base model (C statistic, 0.78 [95% CI, 0.71-0.85] vs 0.69 [95% CI, 0.62-0.77]; P < 0.001). A ≥10% SCr level decrease predicted significantly lower AKI risk (OR, 0.37; 95% CI, 0.18-0.76), whereas a ≥10% SCr level increase predicted significantly higher (OR, 6.38; 95% CI, 2.37-17.2) AKI risk compared with the reference category. We used a surrogate marker of AKI. External validation of our results is warranted. In elective cardiac surgery patients, measurement of immediate postoperative ΔSCr improves prediction of AKI.

Ho J ，Reslerova M ，Gali B ，Nickerson PW ，Rush DN ，Sood MM ，Bueti J ，Komenda P ，Pascoe E ，Arora RC ，Rigatto C ... -  《-》

An assessment of the Acute Kidney Injury Network creatinine-based criteria in patients submitted to mechanical ventilation.

Lombardi R ，Nin N ，Lorente JA ，Frutos-Vivar F ，Ferguson ND ，Hurtado J ，Apezteguia C ，Desmery P ，Raymondos K ，Tomicic V ，Cakar N ，González M ，Elizalde J ，Nightingale P ，Abroug F ，Jibaja M ，Arabi Y ，Moreno R ，Matamis D ，Anzueto A ，Esteban A ，VENTILA Group ... -  《-》

Validation of clinical scores predicting severe acute kidney injury after cardiac surgery.

Acute kidney injury (AKI) requiring renal replacement therapy (RRT) in patients undergoing cardiac surgery is associated strongly with adverse patient outcomes. Recently, 3 predictive risk models for RRT have been developed. The aims of our study are to validate the predictive scoring models for patients requiring postoperative RRT and test applicability to the broader spectrum of patients with postoperative severe AKI. Diagnostic test study. 12,096 patients undergoing cardiac surgery with cardiopulmonary bypass at Mayo Clinic, Rochester, MN, from 2000 through 2007. Cleveland Clinic score, Mehta score, and Simplified Renal Index (SRI) score. Incidence of postoperative RRT or composite outcome of severe AKI, defined as serum creatinine level >2.0 mg/dL, and a 2-fold increase compared with the preoperative baseline creatinine level or RRT. RRT was used in 254 (2.1%) patients, whereas severe AKI was present in 467 (3.9%). Discrimination for the prediction of RRT and severe AKI was good for all scoring models measured using areas under the receiver operating characteristic curve (AUROCs): 0.86 (95% CI, 0.84-0.88) for RRT and 0.81 (95% CI, 0.79-0.83) for severe AKI using the Cleveland score, 0.81 (95% CI, 0.78-0.86) and 0.76 (95% CI, 0.73-0.80) using the Mehta score, and 0.79 (95% CI, 0.77-0.82) and 0.75 (95% CI, 0.72-0.77) using the SRI score. The Cleveland score and Mehta score consistently showed significantly better discrimination compared with the SRI score (P < 0.001). Despite lower AUROCs for the prediction of severe AKI, the Cleveland score AUROC was still >0.80. The Mehta score is applicable in only a subgroup of patients. Single-center retrospective cohort study. The Cleveland scoring system offers the best discriminative value to predict postoperative RRT and covers most patients undergoing cardiac surgery. It also can be used for prediction of the composite end point of severe AKI, which enables broader application to patients at risk of postoperative kidney dysfunction.

Englberger L ，Suri RM ，Li Z ，Dearani JA ，Park SJ ，Sundt TM 3rd ，Schaff HV ... -  《-》

Early postoperative change in serum creatinine predicts acute kidney injury after cardiothoracic surgery: a retrospective cohort study.

Oka H ，Yamada S ，Kamimura T ，Harada A ，Tsuruya K ，Nakano T ，Kitazono T ... -  《-》

Acute kidney injury after lung resection surgery: incidence and perioperative risk factors.

Ishikawa S ，Griesdale DE ，Lohser J 《-》