National surgical quality improvement program underestimates the risk associated with mild and moderate postoperative acute kidney injury.
National surgical quality improvement program underestimates the risk associated with mild and moderate postoperative acute kidney injury.
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DOI：
10.1097/ccm.0b013e31829860fc
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发表时间：
2013-11
影响因子：
8.8
通讯作者：
Hobson CE
中科院分区：
文献类型：
--
作者：
Bihorac A;Brennan M;Ozrazgat-Baslanti T;Bozorgmehri S;Efron PA;Moore FA;Segal MS;Hobson CE
在手术患者的单中心队列中，我们评估了术后血清肌酐（sCr）变化与不良结局之间的相关性，并将美国外科医师学会国家手术质量改进计划（ACS NSQIP）对急性肾损伤（NSQIP-AKI）的定义与共识步枪（风险、损伤、衰竭、损失和终末期肾脏）和KDIGO（肾脏疾病：改善全球结局）定义进行了比较。回顾性单中心队列。学术三级医疗中心。27，841例既往无慢性肾脏病史的成人患者接受大手术。步枪将阿基定义为sCr变化大于或等于50%，而KDIGO使用相对于参考sCr的0.3 mg/dl变化。由于NSQIP将阿基定义为sCr变化> 2 mg/dl，因此可能低估了与不太严重的阿基相关的风险。通过使术后并发症和死亡率的受试者工作特征（ROC）曲线的灵敏度和特异性沿着最大化，计算sCr变化百分比和绝对值的最佳区分限（ODL）。虽然RIFLE-AKI的患病率为37%，但使用NSQIP定义，只有7%的RIFLE-AKI患者被诊断为阿基。在多变量logistic模型中，步枪或KDIGO-AKI患者的死亡几率是无阿基患者的10倍。与不良术后结局相关的sCr变化的ODL低至0.2 mg/dl，而2.0 mg/dl的NSQIP区分限具有低灵敏度（0.05 - 0.28）。目前的ACS NSQIP定义低估了与轻度和中度阿基相关的风险，否则由共识步枪和KDIGO标准捕获。
In a single-center cohort of surgical patients we assessed the association between postoperative change in serum creatinine (sCr) and adverse outcomes and compared the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP)’s definition for acute kidney injury (NSQIP-AKI) with consensus RIFLE (Risk, Injury, Failure, Loss, and End-stage Kidney) and KDIGO (Kidney Disease: Improving Global Outcomes) definitions. Retrospective single center cohort. Academic tertiary medical center. 27,841 adult patients with no previous history of chronic kidney disease undergoing major surgery. RIFLE defines AKI as change in sCr greater than or equal to 50% while KDIGO uses 0.3 mg/dl change from the reference sCr. Since NSQIP defines AKI as sCr change > 2mg/dl, it may underestimate the risk associated with less severe AKI. The optimal discrimination limits (ODL) for both percent and absolute sCr changes were calculated by maximizing sensitivity and specificity along the receiver operating characteristic (ROC) curves for postoperative complications and mortality. Although prevalence of RIFLE-AKI was 37%, only 7% of RIFLE-AKI patients would be diagnosed with AKI using the NSQIP definition. In multivariable logistic models patients with RIFLE or KDIGO-AKI had a 10 times higher odds of dying compared to patients without AKI. The ODLs for change in sCr associated with adverse postoperative outcomes were as low as 0.2 mg/dl while the NSQIP discrimination limit of 2.0 mg/dl had low sensitivity (0.05 – 0.28). Current ACS NSQIP definition underestimates the risk associated with mild and moderate AKI otherwise captured by the consensus RIFLE and KDIGO criteria.