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Risk factors of cardiac surgery-associated acute kidney injury: development and validation of a perioperative predictive nomogram
- Source :
- Journal of nephrology. 32(6)
- Publication Year :
- 2019
-
Abstract
- Cardiac surgery-associated acute kidney injury (CSA-AKI), one of the most severe complications in patients with cardiac surgery, is associated with considerable morbidity, mortality and high costs thus placing a heavy burden to society. Therefore, we aimed to build a predictive model based on preoperative features in order to early recognize and intervene for patients with high risk of CSA-AKI. In this retrospective cohort study, baseline perioperative hospitalization information of patients who underwent cardiac surgery from October 2012 to October 2017 were screened. After multivariate logistic regression, identified independent predictive factors associated with CSA-AKI were incorporated into the nomogram and the discriminative ability and predictive accuracy of the model was assessed by concordance index (C-Index). Additionally, internal validation was performed by using bootstrapping technology with 1000 resamples to reduce the over-fit bias. In all 4395 patients with cardiac surgery October 2012–October 2017, no patients were excluded for the continuous renal replacement therapy (CRRT) before surgery while 2495 patients were excluded due to only one or less than one Scr assay post-surgery. In the end, a total of 1900 patients were enrolled in the study, of which 698 patients (74.89%) developed AKI stage 1, 158 (16.96%) AKI stage 2 and 76 (8.15%) AKI stage 3. After multivariate logistic regression, age, perioperative estimated glomerular filtration rate (eGFR), lactate dehydrogenase (LDH), prothrombin time (PT), with a history of surgery, transfusion, cardiac arrhythmia, coronary heart disease (CHD), or chronic kidney disease (CKD), using calcium channel blocker (CCB), proton pump inhibitors (PPI), non-steroidal anti-inflammatory drugs (NSAID), antibiotic or statin before surgery were predictive factors of CSA-AKI. In addition, the nomogram demonstrated a good accuracy in estimating CSA-AKI, with an C-Index and a bootstrap-corrected one of 0.796 (SD = 0.018, 95% CI 0.795–0.797) and 0.789 (SD = 0.015, 95% CI 0.788–0.790), respectively. Moreover, calibration plots showed an optimal consistency with the actual presence of CSA-AKI. The novel predictive nomogram achieved a good preoperative prediction of CSA-AKI within the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Though the model, the risk of an individual patient with “subclinical AKI” undergoing cardiac surgery could be determined earlier and such application was helpful for timely intervention in order to improve patient’s prognosis.
- Subjects :
- Nephrology
Male
medicine.medical_specialty
China
medicine.medical_treatment
030232 urology & nephrology
030204 cardiovascular system & hematology
urologic and male genital diseases
Kidney
Risk Assessment
03 medical and health sciences
0302 clinical medicine
Postoperative Complications
Risk Factors
Internal medicine
Medicine
Humans
Renal replacement therapy
Cardiac Surgical Procedures
Retrospective Studies
business.industry
Incidence
Acute kidney injury
Retrospective cohort study
Perioperative
Nomogram
Acute Kidney Injury
Middle Aged
medicine.disease
Prognosis
Cardiac surgery
Nomograms
Female
business
Kidney disease
Follow-Up Studies
Glomerular Filtration Rate
Subjects
Details
- ISSN :
- 17246059
- Volume :
- 32
- Issue :
- 6
- Database :
- OpenAIRE
- Journal :
- Journal of nephrology
- Accession number :
- edsair.doi.dedup.....5175d3d4a8d4065c381b4c413419be21