Simplified clinical risk score to predict acute kidney injury after aortic surgery.
OBJECTIVE
The authors identified risk factors for acute kidney injury (AKI) defined by risk, injury, failure, loss, end-stage (RIFLE) criteria after aortic surgery with cardiopulmonary bypass and constructed a simplified risk score for the prediction of AKI.


METHODS
Retrospective and observational.


METHODS
Single large university hospital.


METHODS
Patients (737) who underwent aortic surgery with cardiopulmonary bypass between 1997 and 2010.


RESULTS
Multivariate logistic regression analysis was used to evaluate risk factors. A scoring model was developed in a randomly selected derivation cohort (n = 417), and was validated on the remaining patients. The scoring model was developed with a score based on regression β-coefficient, and was compared with previous indices as measured by the area under the receiver operating characteristic curve (AUC). The incidence of AKI was 29.0%, and 5.8% required renal replacement therapy. Independent risk factors for AKI were age older than 60 years, preoperative glomerular filtration rate <60 mL/min/1.73 m(2), left ventricular ejection fraction <55%, operation time >7 hours, intraoperative urine output <0.5 mL/kg/h, and intraoperative furosemide use. The authors made a score by weighting them at 1 point each. The risk score was valid in predicting AKI, and the AUC was 0.74 [95% confidence interval (CI): 0.69 to 0.79], which was similar to that in the validation cohort: 0.74 (95% CI: 0.69 to 0.80; p = 0.97). The risk-scoring model showed a better performance compared with previously reported indices.


CONCLUSIONS
The model would provide a simplified clinical score stratifying the risk of postoperative AKI in patients undergoing aortic surgery.
Department of Anesthesiology and Pain Medicine.
Won Ho
WH
Kim
Sangmin M
SM
Lee
Ji Won
JW
Choi
Eun Hee
EH
Kim
Jong Hwan
JH
Lee
Jae Woong
JW
Jung
Joong Hyun
JH
Ahn
Ki Ick
KI
Sung
Chung Su
CS
Kim
Hyun Sung
HS
Cho
D058186:Acute Kidney Injury / Q000453:epidemiology*; D000328:Adult; D000367:Age Factors; D000368:Aged; D000758:Anesthesia; D001013:Aorta, Thoracic / Q000601:surgery; D019540:Area Under Curve; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002315:Cardiopulmonary Bypass; D015331:Cohort Studies; D004232:Diuretics / Q000627:therapeutic use; D005260:Female; D005665:Furosemide / Q000627:therapeutic use; D006801:Humans; D016013:Likelihood Functions; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care; D011183:Postoperative Complications / Q000453:epidemiology*; D012372:ROC Curve; D018570:Risk Assessment; D016896:Treatment Outcome
D004232:Diuretics; D005665:Furosemide
acute kidney injury; aortic dissection; risk factor; thoracic aortic aneurysm