Dynamic Predictive Scores for Cardiac Surgery–Associated Acute Kidney Injury

Abstract

Background 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. Methods and Results 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. Conclusions 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.