A Predictive Model for Assessing Surgery-Related Acute Kidney Injury Risk in Hypertensive Patients: A Retrospective Cohort Study.
A Predictive Model for Assessing Surgery-Related Acute Kidney Injury Risk in Hypertensive Patients: A Retrospective Cohort Study.
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评估高血压患者手术相关急性肾损伤风险的预测模型：回顾性队列研究
DOI：
10.1371/journal.pone.0165280
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发表时间：
2016
期刊：
影响因子：
3.7
通讯作者：
Yuan H
中科院分区：
文献类型：
--
作者：
Liu X;Ye Y;Mi Q;Huang W;He T;Huang P;Xu N;Wu Q;Wang A;Li Y;Yuan H
背景急性肾损伤（阿基）是一种严重的术后并发症，然而，很少有术前风险模型的阿基已开发的高血压患者接受普通外科手术。因此，在这项涉及大型中国队列的研究中，我们使用术前风险因素开发并验证了手术相关阿基的风险模型。这项回顾性队列研究纳入了24，451例年龄≥18岁的高血压患者，这些患者在2007年至2015年期间接受了普通手术。评估了KDIGO（肾脏疾病：改善全球结局）系统使用的阿基分类终点。使用Fisher评分选择最具鉴别力的预测因子，随后用于构建逐步多元Logistic回归模型，其性能通过与使用净重新分类指数（NRI）和综合鉴别力改善（IDI）指数的其他已发表作品中使用的模型进行比较进行评估。结果1994例（8.2%）住院患者发生手术相关阿基。我们的湘雅模型确定的预测因子是年龄、性别、eGFR、NLR、肺部感染、凝血酶原时间、凝血酶时间、血红蛋白、尿酸、血清钾、血清白蛋白、总胆固醇和天冬氨酸氨基转移酶。验证集和交叉验证集的受试者工作特征曲线下面积（AUC）分别为0.87（95% CI 0.86-0.89）和（0.89; 95% CI 0.88-0.90），因此与训练集的AUC相似（0.89; 95% CI 0.88-0.90）。最佳临界值为0.09。我们的模型优于Kate等人开发的模型，心脏手术患者（n = 2101）的NRI为31.38%（95%CI 25.7%~ 37.1%），IDI为8%（95%CI 5.52%~ 10.50%）。结论/意义我们基于术前风险因素和生物标志物开发了一种阿基风险模型，该模型在预测接受普通外科手术的大队列高血压患者的事件时表现出良好的性能。
Background Acute kidney injury (AKI) is a serious post-surgery complication; however, few preoperative risk models for AKI have been developed for hypertensive patients undergoing general surgery. Thus, in this study involving a large Chinese cohort, we developed and validated a risk model for surgery-related AKI using preoperative risk factors. Methods and Findings This retrospective cohort study included 24,451 hypertensive patients aged ≥18 years who underwent general surgery between 2007 and 2015. The endpoints for AKI classification utilized by the KDIGO (Kidney Disease: Improving Global Outcomes) system were assessed. The most discriminative predictor was selected using Fisher scores and was subsequently used to construct a stepwise multivariate logistic regression model, whose performance was evaluated via comparisons with models used in other published works using the net reclassification index (NRI) and integrated discrimination improvement (IDI) index. Results Surgery-related AKI developed in 1994 hospitalized patients (8.2%). The predictors identified by our Xiang-ya Model were age, gender, eGFR, NLR, pulmonary infection, prothrombin time, thrombin time, hemoglobin, uric acid, serum potassium, serum albumin, total cholesterol, and aspartate amino transferase. The area under the receiver-operating characteristic curve (AUC) for the validation set and cross validation set were 0.87 (95% CI 0.86–0.89) and (0.89; 95% CI 0.88–0.90), respectively, and was therefore similar to the AUC for the training set (0.89; 95% CI 0.88–0.90). The optimal cutoff value was 0.09. Our model outperformed that developed by Kate et al., which exhibited an NRI of 31.38% (95% CI 25.7%-37.1%) and an IDI of 8% (95% CI 5.52%-10.50%) for patients who underwent cardiac surgery (n = 2101). Conclusions/Significance We developed an AKI risk model based on preoperative risk factors and biomarkers that demonstrated good performance when predicting events in a large cohort of hypertensive patients who underwent general surgery.
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DOI：
10.1186/s13054-014-0606-x
发表时间：
2014-11-20
期刊：
Critical care (London, England)
影响因子：
--
作者：
Birnie K;Verheyden V;Pagano D;Bhabra M;Tilling K;Sterne JA;Murphy GJ;UK AKI in Cardiac Surgery Collaborators
通讯作者：
UK AKI in Cardiac Surgery Collaborators
DOI：
10.1053/j.ajkd.2015.02.338
发表时间：
2015-10
期刊：
American journal of kidney diseases : the official journal of the National Kidney Foundation
影响因子：
--
作者：
James MT;Grams ME;Woodward M;Elley CR;Green JA;Wheeler DC;de Jong P;Gansevoort RT;Levey AS;Warnock DG;Sarnak MJ;CKD Prognosis Consortium
通讯作者：
CKD Prognosis Consortium
影响因子：
0.7
作者：
Ferenbach DA;Bonventre JV
通讯作者：
Bonventre JV
影响因子：
13.6
作者：
Kaushal, Gur P.;Shah, Sudhir V.
通讯作者：
Shah, Sudhir V.
影响因子：
13.2
作者：
Demirjian, Sevag;Schold, Jesse D.;Bashour, Charles A.
通讯作者：
Bashour, Charles A.