Limited Predictive Role of the Revised Cardiac Risk Index in Kidney Transplant: Single Center Evaluation and Comparison With International Literature

Olsen, Virgílio da Rocha; Borges, Flávia Kessler; Goldraich, Lívia Adams; Hastenteufel, Laura Caroline Tavares; Amantéa, Rodrigo Pinheiro; Leitão, Santiago Alonso Tobar; Manfro, Roberto Ceratti; Clausell, Nadine Oliveira

doi:10.1016/j.cpcardiol.2021.100908

Cited by 6 publications

(4 citation statements)

References 12 publications

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“…In a Brazilian cohort of 325 kidney transplant recipients, the RCRI score was not associated with major adverse cardiovascular events and had discrimination similar to that in the analyses in our study, with an estimated C-statistic of 0.65 (95% CI: 0.49, 0.78). 42 Although that cohort included a smaller group of kidney failure patients who are generally lower-risk surgical candidates, the findings align with our own and suggest that caution is warranted with use of the RCRI in kidney transplantation as well.…”

Section: Discussionsupporting

confidence: 77%

Using the Revised Cardiac Risk Index to Predict Major Postoperative Events for People With Kidney Failure: An External Validation and Update

Harrison

Hemmelgarn²,

James³

et al. 2022

CJC Open

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Section: Discussionsupporting

confidence: 77%

Using the Revised Cardiac Risk Index to Predict Major Postoperative Events for People With Kidney Failure: An External Validation and Update

Harrison

Hemmelgarn²,

James³

et al. 2022

CJC Open

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“…19 A careful revision of the GSCRI derivation cohort according to age subgroups as shown in the published supplemental material of Alrezk et al study 19 showed a lower discriminative ability of both indices when applied to estimate postoperative MACE in the patients > 85 years, with an AUC of 0.55 and 0.66 for the RCRI and the GSCRI results, respectively, which comes in agreement with our results. The poor discriminative ability of RCRI was also previously reported when externally validated to detect postoperative MACE risk following vascular 29 and renal transplant 30 surgeries.…”

mentioning

confidence: 52%

External Validation of the Revised Cardiac Risk Index and the Geriatric-Sensitive Perioperative Cardiac Risk Index in Oldest Old Patients Following Surgery Under Spinal Anaesthesia; a Retrospective Cross-Sectional Cohort Study

Fayed¹,

Elkhadry²,

Garling³

et al. 2023

CIA

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Background The Revised Cardiac Risk Index (RCRI) and the Geriatric Sensitive Cardiac Risk Index (GSCRI) estimate the risk of postoperative major adverse cardiac events (MACE) regardless of the type of anesthesia and without specifying the oldest old patients. Since spinal anesthesia (SA) is a preferred technique in geriatrics, we aimed to test the external validity of these indices in patients ≥ 80 years old who underwent surgery under SA and tried to identify other potential risk factors for postoperative MACE. Methods The performance of both indices to estimate postoperative in-hospital MACE risk was tested through discrimination, calibration, and clinical utility. We also investigated the correlation between both indices and postoperative ICU admission and length of hospital stay (LOS). Results The MACE incidence was 7.5%. Both indices had limited discriminative (AUC for RCRI and GSCRI were 0.69 and 0.68, respectively) and predictive abilities. The regression analysis showed that patients with atrial fibrillation (AF) were 3.77 and those with trauma surgery were 2.03 times more likely to exhibit MACE, and the odds of MACE increased by 9% for each additional year above 80. Introducing these factors into both indices (multivariable models) increased the discriminative ability (AUC reached 0.798 and 0.777 for RCRI and GSCRI, respectively). Bootstrap analysis showed that the predictive ability of the multivariate GSCRI but not the multivariate RCRI improved. Decision curve analysis (DCA) showed that multivariate GSCRI had superior clinical utility when compared with multivariate RCRI. Both indices correlated poorly with postoperative ICU admission and LOS. Conclusion Both indices had limited predictive and discriminative ability to estimate postoperative in-hospital MACE risk and correlated poorly with postoperative ICU admission and LOS, following surgery under SA in the oldest-old patients. Updated versions by introducing age, AF, and trauma surgery improved the GSCRI performance but not the RCRI.

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“…They contend that because ESRD patients are often excluded or poorly represented in studies designed to evaluate perioperative risk tools, including RCRI, these tools may lack utility in this patient population. 20 Modifications such as the addition of cardiac biomarkers or non-invasive testing could potentially enhance prognostic cardiovascular risk assessment prior to kidney transplant. The care team should have a lower index of suspicion for MACEs in the perioperative period in this patient population, even in the absence of high RCRI score.…”

Section: Kidney Transplantation (Table 1)mentioning

confidence: 99%

Abdominal Organ Transplantation: Noteworthy Literature in 2021

Jules

Blech

Sakai

2022

Semin Cardiothorac Vasc Anesth

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This review highlights noteworthy literature pertinent to anesthesiologists and critical care physicians caring for patients undergoing abdominal organ transplantation. In 2021, we identified noteworthy papers from over 1,200 peer-reviewed publications on pancreatic transplantation, over 1,400 on intestinal transplantation, and over 9,000 on kidney transplantation. The liver transplantation section focuses on clinical trials and systematic reviews and meta-analyses published in 2021 and features 20 selected papers. COVID-19 and abdominal organ transplantation are featured in an independent section.

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Limited Predictive Role of the Revised Cardiac Risk Index in Kidney Transplant: Single Center Evaluation and Comparison With International Literature

Cited by 6 publications

References 12 publications

Using the Revised Cardiac Risk Index to Predict Major Postoperative Events for People With Kidney Failure: An External Validation and Update

Using the Revised Cardiac Risk Index to Predict Major Postoperative Events for People With Kidney Failure: An External Validation and Update

External Validation of the Revised Cardiac Risk Index and the Geriatric-Sensitive Perioperative Cardiac Risk Index in Oldest Old Patients Following Surgery Under Spinal Anaesthesia; a Retrospective Cross-Sectional Cohort Study

Abdominal Organ Transplantation: Noteworthy Literature in 2021

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