Derivation and validation of a simplified predictive index for renal replacement therapy after cardiac surgery
Derivation and validation of a simplified predictive index for renal replacement therapy after cardiac surgery
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DOI：
10.1001/jama.297.16.1801
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发表时间：
2007-04-25
影响因子：
120.7
通讯作者：
Beattie, W. Scott
中科院分区：
文献类型：
--
作者：
Wijeysundera, Duminda N.;Karkouti, Keyvan;Beattie, W. Scott
背景心脏手术后肾脏替代治疗（RRT;血液透析或连续性静脉-静脉血液透析滤过）的预测指数可能会改善临床决策和研究design.Objectives开发一个预测指数RRT使用术前information.Design，设置和参与者回顾性队列的20 131例心脏手术患者在2家医院在安大略，加拿大。推导队列包括10 751例患者在多伦多总医院（1999年至2004年）。验证队列包括多伦多总医院（2004-2005年）的2566例患者和渥太华心脏研究所（1999-2003年）的6814例患者。主要结果测量术后RRT.结果RRT率在推导，多伦多验证，和渥太华验证队列分别为1.3%，1.8%和2.2%。RRT的多变量预测因素包括术前估计的肾小球滤过率、需要药物治疗的糖尿病、左心室射血分数、既往心脏手术、手术、手术紧迫性和术前主动脉内球囊反搏。预测指数为0 ~ 8分。估计的肾小球滤过率小于或等于30 mL/min分配2分;其他成分各分配1分：估计的肾小球滤过率31至60 mL/min、糖尿病、射血分数小于或等于40%、既往心脏手术、冠状动脉旁路移植术以外的手术、主动脉内球囊反搏和非择期病例。53%的患者风险评分较低（≥ 4）。在推导、多伦多验证和渥太华验证队列中，预测指数的受试者工作特征曲线下面积分别为0.81、0.78和0.78。当这些队列分层指数评分的基础上，RRT的似然比更一致比观察RRT rate.Conclusions心脏手术后RRT预测的术前信息。一个简单的预测指数，根据这些信息区分低风险和高风险患者的推导和验证队列。当用于预测RRT的似然比时，该指数提高了泛化能力。
Context A predictive index for renal replacement therapy (RRT; hemodialysis or continuous venovenous hemodiafiltration) after cardiac surgery may improve clinical decision making and research design.Objectives To develop a predictive index for RRT using preoperative information.Design, Setting, and Participants Retrospective cohort of 20 131 cardiac surgery patients at 2 hospitals in Ontario, Canada. The derivation cohort consisted of 10 751 patients at Toronto General Hospital (1999-2004). The validation cohorts consisted of 2566 patients at Toronto General Hospital (2004-2005) and 6814 patients at Ottawa Heart Institute (1999-2003).Main Outcome Measure Postoperative RRT.Results RRT rates in the derivation, Toronto validation, and Ottawa validation cohorts were 1.3%, 1.8%, and 2.2%, respectively. Multivariable predictors of RRT were preoperative estimated glomerular filtration rate, diabetes mellitus requiring medication, left ventricular ejection fraction, previous cardiac surgery, procedure, urgency of surgery, and preoperative intra-aortic balloon pump. The predictive index was scored from 0 to 8 points. An estimated glomerular filtration rate less than or equal to 30 mL/min was assigned 2 points; other components were assigned 1 point each: estimated glomerular filtration rate 31 to 60 mL/min, diabetes mellitus, ejection fraction less than or equal to 40%, previous cardiac surgery, procedure other than coronary artery bypass grafting, intra-aortic balloon pump, and nonelective case. Among the 53% of patients with low risk scores (= 4). The predictive index had areas under the receiver operating characteristic curve in the derivation, Toronto validation, and Ottawa validation cohorts of 0.81, 0.78, and 0.78, respectively. When these cohorts were stratified based on index scores, likelihood ratios for RRT were more concordant than observed RRT rates.Conclusions RRT after cardiac surgery is predicted by readily available preoperative information. A simple predictive index based on this information discriminated well between low- and high-risk patients in derivation and validation cohorts. The index had improved generalizability when used to predict likelihood ratios for RRT.