Dynamic Predictive Scores for Cardiac Surgery-Associated Acute Kidney Injury.

Cardiac surgery-associated acute kidney injury (CSA-AKI) is a common complication with a poor prognosis. In order to identify modifiable perioperative risk factors for AKI, which existing risk scores are insufficient to predict, a dynamic clinical risk score to allow clinicians to estimate the risk of CSA-AKI from preoperative to early postoperative periods is needed. A total of 7233 cardiac surgery patients in our institution from January 2010 to April 2013 were enrolled prospectively and distributed into 2 cohorts. Among the derivation cohort, logistic regression was used to analyze CSA-AKI risk factors preoperatively, on the day of ICU admittance and 24 hours after ICU admittance. Sex, age, valve surgery combined with coronary artery bypass grafting, preoperative NYHA score >2, previous cardiac surgery, preoperative kidney (without renal replacement therapy) disease, intraoperative cardiopulmonary bypass application, intraoperative erythrocyte transfusions, and postoperative low cardiac output syndrome were identified to be associated with CSA-AKI. Among the other 1152 patients who served as a validation cohort, the point scoring of risk factor combinations led to area under receiver operator characteristics curves (AUROC) values for CSA-AKI prediction of 0.74 (preoperative), 0.75 (on the day of ICU admission), and 0.82 (postoperative), and Hosmer-Lemeshow goodness-of-fit tests revealed a good agreement of expected and observed CSA-AKI rates. The first dynamic predictive score system, with Kidney Disease: Improving Global Outcomes (KDIGO) AKI definition, was developed and predictive efficiency for CSA-AKI was validated in cardiac surgery patients.

Jiang W ，Teng J ，Xu J ，Shen B ，Wang Y ，Fang Y ，Zou Z ，Jin J ，Zhuang Y ，Liu L ，Luo Z ，Wang C ，Ding X ... -  《Journal of the American Heart Association》

Preoperative plasma growth-differentiation factor-15 for prediction of acute kidney injury in patients undergoing cardiac surgery.

Heringlake M ，Charitos EI ，Erber K ，Berggreen AE ，Heinze H ，Paarmann H ... -  《CRITICAL CARE》

Validation of Four Prediction Scores for Cardiac Surgery-Associated Acute Kidney Injury in Chinese Patients.

Jiang W ，Xu J ，Shen B ，Wang C ，Teng J ，Ding X ... -  《-》

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 ... -  《-》

Chronic kidney disease as major determinant of the renal risk related to on-pump cardiac surgery: a single-center cohort study.

Hougardy JM ，Revercez P ，Pourcelet A ，Oumeiri BE ，Racapé J ，Le Moine A ，Vanden Eynden F ，De Backer D ... -  《ACTA CHIRURGICA BELGICA》