Acute kidney injury risk prediction score for critically-ill surgical patients

Abstract

Background: There has been a global increase in the incidence of acute kidney injury (AKI), including among critically-ill surgical patients. AKI prediction score provides an opportunity for early detection of patients who are at risk of AKI; however, most of the AKI prediction scores were derived from cardiothoracic surgery. Therefore, we aimed to develop an AKI prediction score for major non-cardiothoracic surgery patients who were admitted to the intensive care unit (ICU). Methods: The data of critically-ill patients from non-cardiothoracic operations in the Thai Surgical Intensive Care Unit (THAI-SICU) study were used to develop an AKI prediction score. Independent prognostic factors from regression analysis were included as predictors in the model. The outcome of interest was AKI within 7 days after the ICU admission. The AKI diagnosis was made according to the Kidney Disease Improving Global Outcomes (KDIGO)-2012 serum creatinine criteria. Diagnostic function of the model was determined by area under the Receiver Operating Curve (AuROC). Risk scores were categorized into four risk probability levels: low (0-2.5), moderate (3.0-8.5), high (9.0-11.5), and very high (12.0-16.5) risk. Risk of AKI was presented as likelihood ratios of positive (LH+). Results: A total of 3474 critically-ill surgical patients were included in the model; 333 (9.6%) developed AKI. Using multivariable logistic regression analysis, older age, high Sequential Organ Failure Assessment (SOFA) non-renal score, emergency surgery, large volume of perioperative blood loss, less urine output, and sepsis were identified as independent predictors for AKI. Then AKI prediction score was created from these predictors. The summation of the score was 16.5 and had a discriminative ability for predicting AKI at AuROC = 0.839 (95% CI 0.825-0.852). LH+ for AKI were: low risk = 0.117 (0.063-0.200); moderate risk = 0.927 (0.745-1.148); high risk = 5.190 (3.881-6.910); and very high risk = 9.892 (6.230-15.695), respectively. Conclusions: The function of AKI prediction score to predict AKI among critically ill patients who underwent noncardiothoracic surgery was good. It can aid in early recognition of critically-ill surgical patients who are at risk from ICU admission. The scores could guide decision making for aggressive strategies to prevent AKI during the perioperative period or at ICU admission.

Incidence, risk factors and outcome of acute kidney injury (AKI) in patients with COVID-19

“…Furthermore, extrarenal SOFA score has been identified as independent predictors for AKI in a cohort of non-COVID-19 critically ill surgical patients. [ 47 ] In the setting of SARS-CoV-2 infection, a study conducted on 5216 US veterans provided evidence that older age, male sex and lower baseline eGFR were independent risk factors for AKI during hospitalization. [ 48 ] In parallel to our findings, several studies confirmed that age [ 7 , 49 , 50 ], male gender [ 50 , 51 ], severe COVID-19 (respiratory distress) [ 52 ] and CKD [ 49 , 51 ] were independent risk factors for the development of COVID-19-associated AKI during hospitalization.…”

External Validation of the Acute Kidney Injury Risk Prediction Score for Critically Ill Surgical Patients Who Underwent Major Non-Cardiothoracic Surgery

“…The average AKI prediction score between the derivation and the validation cohorts were significantly different (8.5 ± 3.2 vs. 7.8 ± 3.5 (STD = 0.216) for patients with AKI, and 4.1 ± 2.9 vs. 4.9 ± 2.3 (STD = −0.279) for patients without AKI, respectively). The detailed description of the performance of the AKI prediction score during the derivation was reported in our previous work [ 23 ]. In terms of discriminative ability, the AKI prediction score showed significantly higher discriminative ability in the derivation cohort ( Figure 2 a) than in the validation cohort (STD = 0.245) ( Figure 2 b).…”

“…A screening criterion was used to identify the proper study domain for prediction as follows: adult patients (age equal to 18 and over) who underwent a major non-cardiothoracic operation and were admitted to the ICU for more than 24 hours. A total of 3474 critically ill surgical patients were used during the AKI prediction score derivation [ 23 ]. The incidence of AKI within seven days was 9.6%.…”

“…The apparent discriminative ability of the score based on the area under the receiver operating characteristic curve (AuROC) was 0.839 (95%CI 0.825–0.852). The score also showed acceptable calibration, according to Hosmer–Lemeshow (HL) statistic ( p -value = 0.302) [ 23 ].…”

“…In 2020, the clinical score for predicting AKI in surgical patients who underwent major non-cardiothoracic surgery and were admitted to the ICU was developed from a large prospective multi-center observational cohort in Thailand [ 23 ]. To the best of our knowledge, this AKI prediction score was the only score that was specifically developed for this specific domain of surgical patients (i.e., major non-cardiothoracic surgery, other than orthopedic surgery, liver resection, or liver transplantation).…”