Acquired cardiovascular disease
Prediction of acute kidney injury within 30 days of cardiac surgery

https://doi.org/10.1016/j.jtcvs.2013.06.049Get rights and content
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Objective

To predict acute kidney injury after cardiac surgery.

Methods

The study included 28,422 cardiac surgery patients who had had no preoperative renal dialysis from June 2001 to June 2009 in 18 hospitals. Logistic regression analyses were undertaken to identify the best combination of risk factors for predicting acute kidney injury. Two models were developed, one including the preoperative risk factors and another including the pre-, peri-, and early postoperative risk factors. The area under the receiver operating characteristic curve was calculated, using split-sample internal validation, to assess model discrimination.

Results

The incidence of acute kidney injury was 5.8% (1642 patients). The mortality for patients who experienced acute kidney injury was 17.4% versus 1.6% for patients who did not. On validation, the area under the curve for the preoperative model was 0.77, and the Hosmer-Lemeshow goodness-of-fit P value was .06. For the postoperative model area under the curve was 0.81 and the Hosmer-Lemeshow P value was .6. Both models had good discrimination and acceptable calibration.

Conclusions

Acute kidney injury after cardiac surgery can be predicted using preoperative risk factors alone or, with greater accuracy, using pre-, peri-, and early postoperative risk factors. The ability to identify high-risk individuals can be useful in preoperative patient management and for recruitment of appropriate patients to clinical trials. Prediction in the early stages of postoperative care can guide subsequent intensive care of patients and could also be the basis of a retrospective performance audit tool.

CTSNet classification

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Abbreviations and Acronyms

AKI
acute kidney injury
ANZSCTS
Australian and New Zealand Society of Cardiac and Thoracic Surgeons
AUC
area under the receiver operating characteristic curve
BIC
Bayesian information criteria
HL-P
Hosmer-Lemeshow P value
IABP
intra-aortic balloon pump
MSE
mean square error
NYHA
New York Heart Association
RBC
red blood cell
RRT
renal replacement therapy

Cited by (0)

The Australasian Society of Cardiac and Thoracic Surgeons National Cardiac Surgery Database Program is funded by the Department of Health Victoria, and the Health Administration Corporation and the Clinical Excellence Commission, New South Wales.

Disclosures: Authors have nothing to disclose with regard to commercial support.

Drs Ng and Sanagou are joint first authors.