A clinical score to predict acute renal failure after cardiac surgery
A clinical score to predict acute renal failure after cardiac surgery
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DOI：
10.1681/asn.2004040331
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发表时间：
2005-01-01
影响因子：
13.6
通讯作者：
Paganini, EP
中科院分区：
文献类型：
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作者：
Thakar, CV;Arrigain, S;Paganini, EP
心脏直视手术后急性肾功能衰竭（ARF）的死亡率仍然很高。ARF的准确预测为制定早期诊断和治疗策略提供了机会。本研究的目的是通过综合所有主要危险因素的影响，开发一种预测术后ARF的临床评分。1993年至2002年，共有33,217名患者在克利夫兰临床基金会接受了心内直视手术。主要结局是需要透析的ARF。在随机选择的测试集（n = 15，838）中开发评分模型，并在其余患者中进行验证。通过受试者工作特征曲线下面积比较其预测准确性。分数在0到17分之间。验证集中每个评分水平的ARF频率均在测试集中相应频率的95%置信区间（CI）内。严重程度增加的4个风险类别（评分0 - 2、3 - 5、6 - 8）。9至13）是任意形成的。在测试集中，这些类别的ARF频率范围为0.5%至22.1%。该评分在预测所有风险类别的ARF方面也是有效的。测试集中评分的受试者工作特征曲线下面积为0.81（95% CI 0.78 - 0.83），与验证集中的受试者工作特征曲线下面积相似（0.82; 95% CI 0.80 - 0.85; P = 0.39）。总之，评分在预测心脏直视手术后ARF方面是有效和准确的;沿着其临床效用的增加，评分可以帮助规划未来的ARF临床试验。
The risk of mortality associated with acute renal failure (ARF) after open-heart surgery continues to be distressingly high. Accurate prediction of ARF provides an opportunity to develop strategies for early diagnosis and treatment. The aim of this study was to develop a clinical score to predict postoperative ARF by incorporating the effect of all of its major risk factors. A total of 33,217 patients underwent open-heart surgery at the Cleveland Clinic Foundation (1993 to 2002). The primary outcome was ARF that required dialysis. The scoring model was developed in a randomly selected test set (n = 15,838) and was validated on the remaining patients. Its predictive accuracy was compared by area under the receiver operating characteristic curve. The score ranges between 0 and 17 points. The ARF frequency at each score level in the validation set fell within the 95% confidence intervals (CI) of the corresponding frequency in the test set. Four risk categories of increasing severity (scores 0 to 2, 3 to 5, 6 to 8. and 9 to 13) were formed arbitrarily. The frequency of ARF across these categories in the test set ranged between 0.5 and 22.1%. The score was also valid in predicting ARF across all risk categories. The area under the receiver operating characteristic curve for the score in the test set was 0.81 (95% CI 0.78 to 0.83) and was similar to that in the validation set (0.82; 95% CI 0.80 to 0.85; P = 0.39). In conclusion, a score is valid and accurate in predicting ARF after open-heart surgery; along with increasing its clinical utility, the score can help in planning future clinical trials of ARF.