Comparison of contemporary preoperative risk models at predicting acute kidney injury after isolated coronary artery bypass grafting: a retrospective cohort study

Abstract

ObjectivesAcute kidney injury (AKI) after coronary artery bypass grafting (CABG) is associated with short-term and long-term adverse outcomes. The European System for Cardiac Operative Risk Evaluation (EuroSCORE), EuroSCORE II, the Society of Thoracic Surgeons (STS) score and Age, Creatinine and Ejection Fraction (ACEF) score, have been widely used for predicting the operative risk of cardiac surgery. The aim of this study is to investigate the discriminant ability among current available models in predicting postoperative AKI.MethodsFrom January 2010 to December 2012, 353 patients who underwent isolated CABG were enrolled. The clinical characteristics, outcomes and scores of prognostic models were collected. The primary outcome was postoperative AKI, defined based on the Kidney Disease Improving Global Outcome (KDIGO) Clinical Practice Guideline for AKI, in 2012.Results102 patients (28.9%) developed postoperative AKI. For AKI prediction, EuroSCORE II, STS score and ACEF score were all good tools for stage-3 AKI. The ACEF score was shown to have satisfied discriminant ability to predict postoperative AKI with area under a receiver operating characteristic curve: 0.781±0.027, (95% CI 0.729 to 0.834, p value <0.001). Multivariate logistic analysis identified that lower ejection fraction and higher serum creatinine were independent risk factors for AKI.ConclusionsThe simple and extremely user-friendly ACEF score can accurately identify the risk of postoperative AKI and has shown satisfactory discriminant ability when compared with other systems. The ACEF score might be the easiest tool for predicting postoperative AKI.

Decreased mean perfusion pressure as an independent predictor of acute kidney injury after cardiac surgery

“…As expected, there were differences between those who did and those who did not develop AKICS with regard to their global scores for survival (EuroScore, logEuro, Aus-Score) as well as the proportion of patients who had valve surgery, emergency surgery, previous cardiac surgery, and infective endocarditis ( Table 1). These associations have been noted previously [8,9]. However, our modelling enabled us to determine the contribution that particular aspects of pathophysiology had towards adverse renal outcomes amongst the entire cohort and our modelling can, therefore, assist with hypothesis generation for therapeutic targets.…”

“…Patients who develop AKICS are known to have a higher EuroScore, and be more likely to have valve surgery, emergency surgery or previous cardiac surgery [8,9]. Nevertheless, these associations do not provide information as to the pathophysiological mechanism for the evolution of AKI.…”

Predictors of Postoperative Acute Kidney Injury after Coronary Artery Bypass Graft Surgery

“…This scoring system may be an applicable model to predict postoperative AKI development because it uses clinical data, which can be readily and rapidly obtained, making it very appropriate for elective or urgent surgery [23] . More effort is required to develop and validate different prediction models to identify postoperative AKI in an easy-to-use, accurate pattern.…”

Biomarkers for acute cardiorenal syndrome

“…4 CRS I can also occur following cardiac surgery. 5,6 CRS I is associated with increased mortality, duration of hospitalization, rate of re-hospitalization and risk of progression to stage 4-5 chronic kidney disease. 7 In patients with ADHF requiring extracorporeal membrane oxygenation devices, the incidence of AKI is 75.5% and the stage of AKI is associated with mortality.…”

“…The incidence of AKI following ACS is approximately 12.0%–37.0% . CRS I can also occur following cardiac surgery . CRS I is associated with increased mortality, duration of hospitalization, rate of re‐hospitalization and risk of progression to stage 4–5 chronic kidney disease .…”