Predictive models for kidney disease: improving global outcomes (KDIGO) defined acute kidney injury in UK cardiac surgery.
Predictive models for kidney disease: improving global outcomes (KDIGO) defined acute kidney injury in UK cardiac surgery.
复制标题
DOI：
10.1186/s13054-014-0606-x
复制
发表时间：
2014-11-20
期刊：
影响因子：
--
通讯作者：
UK AKI in Cardiac Surgery Collaborators
中科院分区：
文献类型：
--
作者：
Birnie K;Verheyden V;Pagano D;Bhabra M;Tilling K;Sterne JA;Murphy GJ;UK AKI in Cardiac Surgery Collaborators
急性肾损伤(AKI)风险预测评分是一种客观和透明的手段，可以在临床试验中丰富队列或在手术前对患者进行风险分层。现有的评分是有限的，因为它们只被设计成预测严重的或非共识的AKI定义，而不是不那么严重的AKI阶段，这也具有预后意义。这项研究的目的是开发和验证新的风险评分，可以识别所有有AKI风险的患者。前瞻性常规收集的临床数据(n = 30,854)来自3个英国心脏外科中心(布里斯托尔、伯明翰和伍尔弗汉普顿)。AKI的定义是根据肾脏疾病：改善全球结局(KDIGO)指南。该模型是使用布里斯托尔和伯明翰的数据集开发的，并使用伍尔弗汉普顿的数据进行了外部验证。模型识别率用ROC曲线下面积(AUC)估计。使用Hosmer-Lemesshow检验和校准曲线图对模型校准进行评估。诊断效用也与现有的评分进行了比较。AUCSCORE0.74(95%可信区间(CI)0.72，0.76)对AKI各期的风险预测得分与EUROSCORE评分和克利夫兰临床评分相比显示出更好的区分性，而与 = 和NG值的区分性相当。Any阶段AKI评分显示出比四个比较分数更好的校正效果。3期AKI风险预测评分也显示出良好的区分性(AUC=0.78(95%CI 0.75，0.80))，4种比较风险评分也是如此，但3期AKI评分的校正效果较差。这是第一个准确识别任何阶段AKI风险的风险评分。这一评分在高危患者的围手术期处理以及临床试验设计中将是有用的。
Acute kidney injury (AKI) risk prediction scores are an objective and transparent means to enable cohort enrichment in clinical trials or to risk stratify patients preoperatively. Existing scores are limited in that they have been designed to predict only severe, or non-consensus AKI definitions and not less severe stages of AKI, which also have prognostic significance. The aim of this study was to develop and validate novel risk scores that could identify all patients at risk of AKI. Prospective routinely collected clinical data (n = 30,854) were obtained from 3 UK cardiac surgical centres (Bristol, Birmingham and Wolverhampton). AKI was defined as per the Kidney Disease: Improving Global Outcomes (KDIGO) Guidelines. The model was developed using the Bristol and Birmingham datasets, and externally validated using the Wolverhampton data. Model discrimination was estimated using the area under the ROC curve (AUC). Model calibration was assessed using the Hosmer–Lemeshow test and calibration plots. Diagnostic utility was also compared to existing scores. The risk prediction score for any stage AKI (AUC = 0.74 (95% confidence intervals (CI) 0.72, 0.76)) demonstrated better discrimination compared to the Euroscore and the Cleveland Clinic Score, and equivalent discrimination to the Mehta and Ng scores. The any stage AKI score demonstrated better calibration than the four comparison scores. A stage 3 AKI risk prediction score also demonstrated good discrimination (AUC = 0.78 (95% CI 0.75, 0.80)) as did the four comparison risk scores, but stage 3 AKI scores were less well calibrated. This is the first risk score that accurately identifies patients at risk of any stage AKI. This score will be useful in the perioperative management of high risk patients as well as in clinical trial design.
登录
查看更多内容
影响因子：
13.2
作者：
Demirjian, Sevag;Schold, Jesse D.;Bashour, Charles A.
通讯作者：
Bashour, Charles A.
影响因子：
13.6
作者：
Thakar, CV;Arrigain, S;Paganini, EP
通讯作者：
Paganini, EP
影响因子：
19.6
作者：
Siew, Edward D.;Matheny, Michael E.;Ikizler, T. Alp;Lewis, Julie B.;Miller, Randolph A.;Waitman, Lemuel R.;Go, Alan S.;Parikh, Chirag R.;Peterson, Josh F.
通讯作者：
Peterson, Josh F.
影响因子：
13.2
作者：
Englberger, Lars;Suri, Rakesh M.;Schaff, Hartzell V.
通讯作者：
Schaff, Hartzell V.
影响因子：
3.4
作者：
Nashef, SAM;Roques, F;Ferguson, TB
通讯作者：
Ferguson, TB