title: Predicting cardiac surgery-associated acute kidney injury: The CRATE score.
abstract: OBJECTIVE
  Acute kidney injury (AKI) is a frequent complication after cardiac surgery and is associated with increased mortality. The aim was to design a nondialytic AKI score in patients with previously normal renal function undergoing cardiac surgery.
  
  
  METHODS
  Data were collected on 909 patients who underwent cardiac surgery with cardiopulmonary bypass between 2012 and 2014. A total of 810 patients fulfilled the inclusion criteria. Patients were classified as having AKI based on the RIFLE criteria. Postoperative AKI occurred in 137 patients (16.9%). Several parameters were recorded preoperatively, intraoperatively, and at intensive care unit admission, looking for a univariate and multivariate association with AKI risk. A second data set of 741 patients, from 2 different hospitals, was recorded as a validation cohort.
  
  
  RESULTS
  Four independent risk factors were included in the CRATE score: creatinine (odds ratio [OR], 9.66; 95% confidence interval [CI], 4.77-19.56; P < .001), EuroSCORE (OR, 1.40; CI, 1.29-1.52; P < .001), lactate (OR, 1.03; CI, 1.01-1.04; P < .001), and cardiopulmonary bypass time (OR, 1.01; CI, 1.01-1.02; P < .001). The accuracy of the model was good, with an area under the curve of 0.89 (CI, 0.85-0.92). The CRATE score retained good discrimination in validation cohort, with an area under the curve of 0.81 (95% CI, 0.78-0.85).
  
  
  CONCLUSIONS
  CRATE score is an accurate and easy to calculate risk score that uses affordable and widely available variables in the routine care surgical patients.
authors.affiliation: Department of Anesthesiology and Reanimation, Hospital Clinico Universitario de Valladolid, Valladolid, Spain.
authors.forename: Pablo
authors.initials: P
authors.lastname: Jorge-Monjas
authors.affiliation: Department of Cardiovascular Surgery, Hospital Universitario de La Princesa, Madrid, Spain. Electronic address: jbustamantemunguira@gmail.com.
authors.forename: Juan
authors.initials: J
authors.lastname: Bustamante-Munguira
authors.affiliation: Department of Anesthesiology and Reanimation, Hospital Clinico Universitario de Valladolid, Valladolid, Spain.
authors.forename: Mario
authors.initials: M
authors.lastname: Lorenzo
authors.affiliation: Department of Anesthesiology and Reanimation, Hospital Clinico Universitario de Valladolid, Valladolid, Spain; Immunity, Risk of Infection and Sepsis group (IRIS), Hospital Clínico Universitario de Valladolid, Valladolid, Spain.
authors.forename: María
authors.initials: M
authors.lastname: Heredia-Rodríguez
authors.affiliation: Department of Pharmacology and Therapeutics, Valladolid University Physicians College, Valladolid, Spain.
authors.forename: Inmaculada
authors.initials: I
authors.lastname: Fierro
authors.affiliation: Department of Anesthesiology and Reanimation, Hospital Clinico Universitario de Valladolid, Valladolid, Spain; Immunity, Risk of Infection and Sepsis group (IRIS), Hospital Clínico Universitario de Valladolid, Valladolid, Spain.
authors.forename: Esther
authors.initials: E
authors.lastname: Gómez-Sánchez
authors.affiliation: Department of Anesthesiology and Reanimation, Hospital Clinico Universitario de Valladolid, Valladolid, Spain.
authors.forename: Alfonso
authors.initials: A
authors.lastname: Hernandez
authors.affiliation: Department of Pharmacology and Therapeutics, Valladolid University Physicians College, Valladolid, Spain.
authors.forename: Francisco J
authors.initials: FJ
authors.lastname: Álvarez
authors.affiliation: Immunity, Risk of Infection and Sepsis group (IRIS), Hospital Clínico Universitario de Valladolid, Valladolid, Spain; Infection & Immunity Medical Investigation group, Hospital Clínico Universitario-IECSCYL, Valladolid, Spain.
authors.forename: Jesús F
authors.initials: JF
authors.lastname: Bermejo-Martin
authors.affiliation: Department of Anesthesiology and Reanimation, Hospital Clinico Universitario de Valladolid, Valladolid, Spain.
authors.forename: Estefanía
authors.initials: E
authors.lastname: Gómez-Pesquera
authors.affiliation: Department of Anesthesiology and Reanimation, Hospital Clinico Universitario de Valladolid, Valladolid, Spain; Immunity, Risk of Infection and Sepsis group (IRIS), Hospital Clínico Universitario de Valladolid, Valladolid, Spain.
authors.forename: José I
authors.initials: JI
authors.lastname: Gómez-Herreras
authors.affiliation: Department of Anesthesiology and Reanimation, Hospital Clinico Universitario de Valladolid, Valladolid, Spain; Immunity, Risk of Infection and Sepsis group (IRIS), Hospital Clínico Universitario de Valladolid, Valladolid, Spain.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Tamayo
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality; D000368:Aged; D015415:Biomarkers / Q000097:blood; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D003404:Creatinine / Q000097:blood; D005260:Female; D006801:Humans; D007677:Kidney Function Tests; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011183:Postoperative Complications / Q000401:mortality; D011237:Predictive Value of Tests; D012372:ROC Curve; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors
chemical_list: D015415:Biomarkers; D003404:Creatinine
keywords: Cardiac surgery; Renal insufficiency; Risk prediction; Risk score