Dynamic Predictive Scores for Cardiac Surgery-Associated Acute Kidney Injury.
Dynamic Predictive Scores for Cardiac Surgery-Associated Acute Kidney Injury.
复制标题
心脏手术相关急性肾损伤的动态预测评分
DOI：
10.1161/jaha.116.003754
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发表时间：
2016-08-04
影响因子：
5.4
通讯作者：
Ding X
中科院分区：
文献类型：
--
作者：
Jiang W;Teng J;Xu J;Shen B;Wang Y;Fang Y;Zou Z;Jin J;Zhuang Y;Liu L;Luo Z;Wang C;Ding X
心脏手术相关的急性肾损伤（CSA‐阿基）是一种预后不良的常见并发症。为了确定阿基的可修改围手术期风险因素，现有风险评分不足以预测，需要动态临床风险评分，以允许临床医生估计从术前到术后早期的CSA‐阿基风险。2010年1月至2013年4月期间，我院共前瞻性入组7233例心脏手术患者，并将其分为2个队列。在衍生队列中，使用logistic回归分析术前、入住ICU当天和入住ICU后24小时的CSA‐阿基风险因素。性别、年龄、瓣膜手术联合冠状动脉旁路移植术、术前NYHA评分>2、既往心脏手术、术前肾脏（无肾脏替代治疗）疾病、术中心肺转流应用、术中红细胞输注和术后低心输出量综合征被确定为与CSA‐阿基相关。在作为验证队列的其他1152例患者中，风险因素组合的点评分导致阿基预测的受试者工作特征曲线下面积（AUROC）值为0.74（术前）、0.75（ICU入院当天）和0.82（术后），Hosmer-Lemeshow拟合优度检验显示预期和观察到的阿基发生率具有良好的一致性。开发了第一个动态预测评分系统，即肾脏疾病：改善全球结局（KDIGO）阿基定义，并在心脏手术患者中验证了CSA‐阿基的预测效率。
Cardiac surgery–associated acute kidney injury (CSA‐AKI) is a common complication with a poor prognosis. In order to identify modifiable perioperative risk factors for AKI, which existing risk scores are insufficient to predict, a dynamic clinical risk score to allow clinicians to estimate the risk of CSA‐AKI from preoperative to early postoperative periods is needed. A total of 7233 cardiac surgery patients in our institution from January 2010 to April 2013 were enrolled prospectively and distributed into 2 cohorts. Among the derivation cohort, logistic regression was used to analyze CSA‐AKI risk factors preoperatively, on the day of ICU admittance and 24 hours after ICU admittance. Sex, age, valve surgery combined with coronary artery bypass grafting, preoperative NYHA score >2, previous cardiac surgery, preoperative kidney (without renal replacement therapy) disease, intraoperative cardiopulmonary bypass application, intraoperative erythrocyte transfusions, and postoperative low cardiac output syndrome were identified to be associated with CSA‐AKI. Among the other 1152 patients who served as a validation cohort, the point scoring of risk factor combinations led to area under receiver operator characteristics curves (AUROC) values for CSA‐AKI prediction of 0.74 (preoperative), 0.75 (on the day of ICU admission), and 0.82 (postoperative), and Hosmer–Lemeshow goodness‐of‐fit tests revealed a good agreement of expected and observed CSA‐AKI rates. The first dynamic predictive score system, with Kidney Disease: Improving Global Outcomes (KDIGO) AKI definition, was developed and predictive efficiency for CSA‐AKI was validated in cardiac surgery patients.