Validation of Clinical Scores Predicting Severe Acute Kidney Injury After Cardiac Surgery
Validation of Clinical Scores Predicting Severe Acute Kidney Injury After Cardiac Surgery
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DOI：
10.1053/j.ajkd.2010.04.017
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发表时间：
2010-10-01
影响因子：
13.2
通讯作者：
Schaff, Hartzell V.
中科院分区：
文献类型：
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作者：
Englberger, Lars;Suri, Rakesh M.;Schaff, Hartzell V.
背景资料：在接受心脏手术的患者中，需要肾脏替代治疗（RRT）的急性肾损伤（阿基）与患者不良结局密切相关。最近，已经开发了3种RRT的预测风险模型。我们研究的目的是验证需要术后RRT的患者的预测评分模型，并测试对更广泛的术后严重阿基患者的适用性。研究设计：诊断测试研究。设置和参与者：2000年至2007年在罗切斯特马约诊所接受体外循环心脏手术的12，096例患者。指数测试：Cleveland Clinic评分、Mehta评分和简化肾脏指数（SRI）评分。参考试验或结局：术后RRT的发生率或严重阿基的复合结局，定义为血清肌酐水平>2.0 mg/dL，并且与术前基线肌酐水平或RRT相比增加2倍。254例（2.1%）患者使用RRT，而467例（3.9%）患者存在重度阿基。对于使用受试者工作特征曲线下面积（AUROC）测量的所有评分模型，预测RRT和重度阿基的区分度良好：0.86 RRT和0.81（95% CI，0.84-0.88）（95% CI，0.79-0.83）对于重度阿基，使用Cleveland评分，0.81使用Mehta评分，分别为0.79（95%CI，0.77 - 0.82）和0.75（95%CI，0.72-0.77）。Cleveland评分和Mehta评分一致显示与SRI评分相比具有显著更好的辨别力（P0. 80）。Mehta评分仅适用于一个亚组的patients.Limitations：单中心回顾性队列study.Conclusions：克利夫兰评分系统提供了最好的判别值来预测术后RRT，并涵盖了大多数接受心脏手术的患者。它还可用于预测严重阿基的复合终点，从而能够更广泛地应用于有术后肾功能不全风险的患者。美国肾脏病杂志56：623-631。(C)2010年，美国国家肾脏基金会（National Kidney Foundation，Inc.）
Background: Acute kidney injury (AKI) requiring renal replacement therapy (RRT) in patients undergoing cardiac surgery is associated strongly with adverse patient outcomes. Recently, 3 predictive risk models for RRT have been developed. The aims of our study are to validate the predictive scoring models for patients requiring postoperative RRT and test applicability to the broader spectrum of patients with postoperative severe AKI.Study Design: Diagnostic test study.Setting & Participants: 12,096 patients undergoing cardiac surgery with cardiopulmonary bypass at Mayo Clinic, Rochester, MN, from 2000 through 2007.Index Test: Cleveland Clinic score, Mehta score, and Simplified Renal Index (SRI) score.Reference Test or Outcome: Incidence of postoperative RRT or composite outcome of severe AKI, defined as serum creatinine level >2.0 mg/dL, and a 2-fold increase compared with the preoperative baseline creatinine level or RRT.Results: RRT was used in 254 (2.1%) patients, whereas severe AKI was present in 467 (3.9%). Discrimination for the prediction of RRT and severe AKI was good for all scoring models measured using areas under the receiver operating characteristic curve (AUROCs): 0.86 (95% CI, 0.84-0.88) for RRT and 0.81 (95% CI, 0.79-0.83) for severe AKI using the Cleveland score, 0.81 (95% CI, 0.78-0.86) and 0.76 (95% CI, 0.73-0.80) using the Mehta score, and 0.79 (95% CI, 0.77-0.82) and 0.75 (95% CI, 0.72-0.77) using the SRI score. The Cleveland score and Mehta score consistently showed significantly better discrimination compared with the SRI score (P0.80. The Mehta score is applicable in only a subgroup of patients.Limitations: Single-center retrospective cohort study.Conclusions: The Cleveland scoring system offers the best discriminative value to predict postoperative RRT and covers most patients undergoing cardiac surgery. It also can be used for prediction of the composite end point of severe AKI, which enables broader application to patients at risk of postoperative kidney dysfunction. Am J Kidney Dis 56: 623-631. (C) 2010 by the National Kidney Foundation, Inc.