Validating a Scoring Tool to Predict Acute Kidney Injury (AKI) following Cardiac Surgery

Canadian Journal of Kidney Health and Disease - 2015
Brian A. Wong1, Jennifer St.Onge2, Stephen Korkola3, Bhanu Prasad4
1College of Medicine – Regina Campus, University of Saskatchewan, Regina General Hospital, 1440-14th Avenue, Regina, SK S4P0W5, Canada
2Research and Performance Support, Regina Qu'Appelle Health Region, Regina, SK, 2180 – 23rd Avenue, Regina, SK S4S 0A5, Canada
3Department of Surgery, Regina Qu'Appelle Health Region, Regina, SK, Regina General Hospital, 1440-14th Avenue, Regina, SK S4P0W5, Canada
4Section of Nephrology, Department of Medicine, Regina Qu'Appelle Health Region, Regina, SK, Regina General Hospital, 1440-14th Avenue, 3401-B Pasqua Street, Regina, SK S4P0W5, Canada

Tóm tắt

Background: Acute kidney injury (AKI) after cardiac surgery is associated with an increased risk of mortality. Preoperative risk scores can identify patients at risk for AKI and facilitate preventive strategies. Currently, validated risk scores are used to predict AKI requiring dialysis (AKI-D); less is known about whether these tools predict less severe forms of AKI. Objective: To evaluate the Cleveland Clinic scoring tool in predicting both AKI-D and less severe stages of AKI in patients after cardiac surgery in a Canadian tertiary care center. Design: Retrospective case-control study. Setting: Regina Qu'Appelle Health Region (RQHR) from 2007 to 2011. Patients: Patients who underwent cardiac surgery and developed postoperative kidney injury (n = 2316). Measurements: Data on risk factors for AKI and outcomes of cardiac surgery were collected from a retrospective chart review. Methods: The primary outcome was AKI, defined as Stage 1 (increase in serum creatinine 1.5–1.9 × baseline within 5 days), Stage 2 (increase 2.0–2.9 × baseline), or Stage 3 (increase 3.0 × baseline or more OR initiation of dialysis during hospital stay). We assessed the performance of a modified version of the Cleveland Clinic tool using receiver operating curve analyses. Results: The incidence of AKI was 6.1% (Stage 1), 2.6% (Stage 2), and 5.8% (Stage 3). The area under the curve (AUC) for the Cleveland score was 0.61 (95% CI: 0.56 to 0.65; p < 0.001) for Stage 1, 0.61 (95% CI: 0.54 to 0.68; p < 0.01) for Stage 2, and 0.78 (95% CI: 0.74 to 0.82; p < 0.001) for Stage 3. Greater level of risk on the Cleveland tool was associated with a higher risk of Stage 3 AKI. Limitations: Lack of prospective validation. Conclusions: The modified Cleveland Clinic tool was valid in identifying patients with severe stages of AKI but did not have strong discrimination for early AKI stages.

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Tài liệu tham khảo

Calvert S, 2012, Perioper Med (Lond), 1, 6, 10.1186/2047-0525-1-6

Chertow GM, 1997, Circulation, 95, 878, 10.1161/01.CIR.95.4.878

Lenihan CR, 2013, Ann Thorac Surg, 95, 20, 10.1016/j.athoracsur.2012.05.131

Mariscalco G, 2011, Ann Thorac Surg, 92, 1539, 10.1016/j.athoracsur.2011.04.123

Rosner MH, 2006, Clin J Am Soc Nephrol, 1, 19, 10.2215/CJN.00240605

Englberger L, 2010, Am J Kidney Dis, 56, 623, 10.1053/j.ajkd.2010.04.017

Hobson CE, 2009, Circulation, 119, 2444, 10.1161/CIRCULATIONAHA.108.800011

Huen SC, 2012, Ann Thorac Surg, 93, 337, 10.1016/j.athoracsur.2011.09.010

Karkouti K, 2009, Circulation, 119, 495, 10.1161/CIRCULATIONAHA.108.786913

Lassnigg A, 2004, J Am Soc Nephrol, 15, 1597, 10.1097/01.ASN.0000130340.93930.DD

Lopez-Delgado JC, 2013, Crit Care, 17, R293, 10.1186/cc13159

Bove T, 2004, J Cardiothorac Vasc Anesth, 18, 442, 10.1053/j.jvca.2004.05.021

Chertow GM, 1998, Am J Med, 104, 343, 10.1016/S0002-9343(98)00058-8

Palomba H, 2007, Kidney Int, 72, 624, 10.1038/sj.ki.5002419

Thakar CV, 2007, Am J Kidney Dis, 50, 703, 10.1053/j.ajkd.2007.07.021

Thakar CV, 2005, J Am Soc Nephrol, 16, 162, 10.1681/ASN.2004040331

Thakar CV, 2003, Am J Kidney Dis, 41, 742, 10.1016/S0272-6386(03)00021-0

Bihorac A, 2009, Ann Surg, 249, 851, 10.1097/SLA.0b013e3181a40a0b

Hansen MK, 2013, Crit Care, 17, R292, 10.1186/cc13158

Loef BG, 2005, J Am Soc Nephrol, 16, 195, 10.1681/ASN.2003100875

Lok CE, 2004, Am Heart J, 148, 430, 10.1016/j.ahj.2003.12.042

Ishani A, 2011, Arch Intern Med, 171, 226, 10.1001/archinternmed.2010.514

Dasta JF, 2008, Nephrol Dial Transplant, 23, 1970, 10.1093/ndt/gfm908

Brown JR, 2014, Ann Thorac Surg, 97, 111, 10.1016/j.athoracsur.2013.07.090

Ho J, 2012, Am J Kidney Dis, 59, 196, 10.1053/j.ajkd.2011.08.023

Park M, 2010, Am J Nephrol, 31, 408, 10.1159/000296277

Kiers HD, 2013, Nephrol Dial Transplant, 28, 345, 10.1093/ndt/gfs518

Candela-Toha A, 2008, Clin J Am Soc Nephrol, 3, 1260, 10.2215/CJN.00560208

Wijeysundera DN, 2007, JAMA, 297, 1801, 10.1001/jama.297.16.1801

Aronson S, 2007, Circulation, 115, 733, 10.1161/CIRCULATIONAHA.106.623538

Brown JR, 2007, Circulation, 116, I139, 10.1161/CIRCULATIONAHA.107.723213

Disease K, 2012, Kidney Int Suppl, 2, 1, 10.1038/kisup.2012.1

Heise D, 2010, Eur J Cardiothorac Surg, 37, 710, 10.1016/j.ejcts.2009.07.018

Mehta RH, 2010, Am J Cardiol, 106, 1728, 10.1016/j.amjcard.2010.07.045

Nally JV, 2002, Cleve Clin J Med, 69, 569, 10.3949/ccjm.69.7.569

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Canadian Journal of Kidney Health and Disease

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