The incidence of acute kidney injury following cardiac surgery (CSA-AKI) is up to 30%, and it places patients at an increased risk of death. The Leicester score (LS) is a new score that predicts CSA-AKI of any stage with better discrimination compared to previous scores. The aim of this study was to identify risk factors for CSA-AKI and to assess the performance of LS. A unicentric retrospective study of patients that required cardiac surgery with cardio-pulmonary bypass (CPB) in 2015 was performed. The inclusion criteria were patients over 18 years old who were operated on for cardiac surgery (valve substitution (VS), Coronary Artery Bypass Graft (CABG), or a combination of both procedures and requiring CPB). CSA-AKI was defined with the Kidney Disease Improving Global Outcomes (KDIGO) criteria. In the multivariate analysis, hypertension (odds ratio 1.883), estimated glomerular filtration rate (EGFR) <60 mL/min (2.365), and peripheral vascular disease (4.66) were associated with the outcome. Both discrimination and calibration were better when the LS was used compared to the Cleveland Clinic Score and Euroscore II, with an area under the curve (AUC) of 0.721. In conclusion, preoperative hypertension in patients with CKD with or without peripheral vasculopathy can identify patients who are at risk of CSA-AKI. The LS was proven to be a valid score that could be used to identify patients who are at risk and who could benefit from intervention studies.
BackgroundThe incidence of acute kidney injury following cardiac surgery (CSA-AKI) is up to 30%, and the risk of chronic kidney disease (CKD) has been found to be higher in these patients compared to the AKI-free population. The aim of our study was to assess the risk of major adverse kidney events (MAKE) [25% or greater decline in estimated glomerular filtration rate (eGFR), new hemodialysis, and death] after cardiac surgery in a Spanish cohort and to evaluate the utility of the score developed by Legouis D et al. (CSA-CKD score) in predicting the occurrence of MAKE.MethodsThis was a single-center retrospective study of patients who required cardiac surgery with cardiopulmonary bypass (CPB) during 2015, with a 1-year follow-up after the intervention. The inclusion criteria were patients over 18 years old who had undergone cardiac surgery [i.e., valve substitution (VS), coronary artery bypass graft (CABG), or a combination of both procedures].ResultsThe number of patients with CKD (eGFR < 60 mL/min) increased from 74 (18.3%) to 97 (24%) within 1 year after surgery. The median eGFR declined from 85 to 82 mL/min in the non-CSA-AKI patient group and from 73 to 65 mL/min in those with CSA-AKI (p = 0.024). Fifty-eight patients (1.4%) presented with MAKE at the 1-year follow-up. Multivariate logistic regression analysis showed that the only variable associated with MAKE was CSA-AKI [odds ratio (OR) 2.386 (1.31–4.35), p = 0.004]. The median CSA-CKD score was higher in the MAKE cohort [3 (2–4) vs. 2 (1–3), p < 0.001], but discrimination was poor, with a receiver operating characteristic curve (AUC) value of 0.682 (0.611–0.754).ConclusionAny-stage CSA-AKI is associated with a risk of MAKE after 1 year. Further research into new measures that identify at-risk patients is needed so that appropriate patient follow-up can be carried out.
Background and Aims cardiac surgery-associated acute kidney injury (CS-AKI) is a frequent complication that confers significant increase in morbility and mortality. It is still unclear how to identify patients at high risk to develop it, in order to apply to them early preventive strategies to avoid AKI. The study aimed to explore risk factors associated to CS-AKI. Method to analyze the association between demographic, pre-operative and intraoperative variables with all grades-AKI, we collected baseline characteristics, type of surgery, aortic time of clampage and extracorporeal circulation time, hemodinamic variables during surgery, Euroscore II, Clevelant Clinic Score and Leicester cardiosurgery score. The post-operative variables included monitorization of the first 24 h in the Intensive Care Units (ICU), consistent in: use of vasoactive drugs, total diuresis, use of furosemide, need of transfusions and need and duration of renal replacement therapy (RRT). Creatinine was collected for all the admision days in order to calculate the incidence of AKI. Also mortality and need of RRT at 30 th day was assessed. The inclusion criteria were: patients over 18 years old who underwent cardiac surgery with extracorporeal circulation. Only valve substitution (VS), Coronary Artery Bypass Graft (CABG) or a combination of both procedures (not including endocarditis surgery) were included. Patients who were already in dialysis or suffered an AKI just before the surgery were not included in the study. Results we included 130 patients who underwent heart surgery intervention in Hospital Clínic de Barcelona from 1st January to 31 st March 2015. 61,5% were men and the majority of them was 60 - 75 years old (46.9%), with hypertension (80.8%), without diabetes (68.5%), with stage 2-Chronic Kidney Disease (53.1%). Main surgical procedure was CABG (50.8%), followed by valve substitution (36.1%) and combination of both (13.1%). 73,1% of the procedures were done electively and 26.9% urgently. Out of the 130 patients, 60 (46.2%) suffered an AKI (36 AKIN 1, 16 AKIN 2 and 8 AKIN3). The majority of the episodes (55.2%) started between 24 and 48 hours after the intervention and 7 patients required RRT. AKI was not associated with mortality or need of renal replacement therapy at 30 days (OR 1.853, p= 0.397). Regarding risk factors for CS-AKI, basal eGFR <60 ml/min, history of hypertension, age and the clevelant/leicester and euroscore were preoperative risk factors associated with CS-AKI in our cohort (OR 5.571 p=<0.001; OR 2.621 p=0.043; OR 1.036 p<0.001; OR 1.453 p=0.045; OR 1.062 p<0.001; OR 1.351 p=0.006 respectively). Leicester cardiosurgery score >30 was the score who showed the best association with AKI (OR 5.167, p<0.001). Intraoperative significant risk factors that were identified were: ischaemia time over 70 minutes (OR 2.876, p=0.004), and the need to use phenylephrine (3.064, p=0.015); whereas the need to use nitroglycerin was identified as a protector (OR 0.441, p=0.031). Conclusion previous eGFR<60 ml/min, age, hypertension, use of phenylephrine during surgery and long ischaemia time are the main factors associated with CS-AKI. Scores like Leicester score can help physicians to identify people at risk and apply preventive strategies.
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