title: Cardiac surgery-associated acute kidney injury: risk factors analysis and comparison of prediction models.
abstract: OBJECTIVE
  Cardiac surgery-associated acute kidney injury (AKI) is a well-known factor influencing patients' long-term morbidity and mortality. Several prediction models of AKI requiring dialysis (AKI-D) have been developed. Only a few direct comparisons of these models have been done. Recently, a new, more uniform and objective definition of AKI has been proposed [Kidney Disease: Improve Global Outcomes (KDIGO)-AKI]. The performance of these prediction models has not yet been tested.
  
  
  METHODS
  Preoperative demographic and clinical characteristics of 1056 consecutive adult patients undergoing cardiac surgery were collected retrospectively for the period 2012-2014. Multivariable logistic regression analysis was used to determine the independent predictors of AKI-D and the KDIGO-AKI stages. Risk scores of five prediction models were calculated using corresponding subgroups of patients. The discrimination of these models was calculated by the c-statistics (area under curve, AUC) and the calibration was evaluated for the model with the highest AUC by calibration plots.
  
  
  RESULTS
  The incidence of AKI-D was 3.5% and for KDIGO-AKI 23% (17.3% for Stage 1, 2.1% for Stage 2 and 3.6% for Stage 3). Older age, atrial fibrillation, NYHA class III or IV heart failure, previous cardiac surgery, higher preoperative serum creatinine and endocarditis were independently associated with the development of AKI-D. For KDIGO-AKI, higher body mass index, older age, female gender, chronic obstructive pulmonary disease, previous cardiac surgery, atrial fibrillation, NYHA class III or IV heart failure, higher preoperative serum creatinine and the use of cardiopulmonary bypass were independent predictors. The model by Thakar et al. showed the best performance in the prediction of AKI-D (AUC 0.837; 95% CI = 0.810-0.862) and also in the prediction of KDIGO-AKI stage 1 and higher (AUC = 0.731; 95% CI = 0.639-0.761), KDIGO-AKI stage 2 and higher (AUC = 0.811; 95% CI = 0.783-0.838) and for KDIGO-AKI stage 3 (AUC = 0.842; 95% CI = 0.816-0.867).
  
  
  CONCLUSIONS
  The performance of known prediction models for AKI-D was found reasonably well in the prediction of KDIGO-AKI, with the model by Thakar having the highest predictive value in the discrimination of patients with risk for all KDIGO-AKI stages.
authors.affiliation: Department of Cardiac Anaesthesia and Intensive Care Medicine, University Hospital Dubrava, Zagreb, Croatia.
authors.forename: Darko
authors.initials: D
authors.lastname: Kristovic
authors.affiliation: Department of Nephrology and Dialysis, University Hospital Dubrava, Zagreb, Croatia ivica.horvatic@yahoo.com.
authors.forename: Ivica
authors.initials: I
authors.lastname: Horvatic
authors.affiliation: Department of Cardiac Anaesthesia and Intensive Care Medicine, University Hospital Dubrava, Zagreb, Croatia.
authors.forename: Ino
authors.initials: I
authors.lastname: Husedzinovic
authors.affiliation: Department of Cardiac and Transplant Surgery, University Hospital Dubrava, Zagreb, Croatia.
authors.forename: Zeljko
authors.initials: Z
authors.lastname: Sutlic
authors.affiliation: Department of Cardiac and Transplant Surgery, University Hospital Dubrava, Zagreb, Croatia.
authors.forename: Igor
authors.initials: I
authors.lastname: Rudez
authors.affiliation: Department of Cardiac and Transplant Surgery, University Hospital Dubrava, Zagreb, Croatia.
authors.forename: Davor
authors.initials: D
authors.lastname: Baric
authors.affiliation: Department of Cardiac and Transplant Surgery, University Hospital Dubrava, Zagreb, Croatia.
authors.forename: Daniel
authors.initials: D
authors.lastname: Unic
authors.affiliation: Department of Cardiac and Transplant Surgery, University Hospital Dubrava, Zagreb, Croatia.
authors.forename: Robert
authors.initials: R
authors.lastname: Blazekovic
authors.affiliation: Department of Nephrology and Dialysis, University Hospital Dubrava, Zagreb, Croatia.
authors.forename: Matija
authors.initials: M
authors.lastname: Crnogorac
mesh_terms: D058186:Acute Kidney Injury / Q000453:epidemiology / Q000209:etiology*; D000368:Aged; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D017523:Croatia / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006331:Heart Diseases / Q000601:surgery*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors
keywords: Acute kidney injury; Cardiac surgery; Dialysis; Kidney Disease: Improve Global Outcomes; Renal replacement therapy; Risk factors