title: Comparison of contemporary preoperative risk models at predicting acute kidney injury after isolated coronary artery bypass grafting: a retrospective cohort study.
abstract: Acute kidney injury (AKI) after coronary artery bypass grafting (CABG) is associated with short-term and long-term adverse outcomes. The European System for Cardiac Operative Risk Evaluation (EuroSCORE), EuroSCORE II, the Society of Thoracic Surgeons (STS) score and Age, Creatinine and Ejection Fraction (ACEF) score, have been widely used for predicting the operative risk of cardiac surgery. The aim of this study is to investigate the discriminant ability among current available models in predicting postoperative AKI.
  
  
  
  From January 2010 to December 2012, 353 patients who underwent isolated CABG were enrolled. The clinical characteristics, outcomes and scores of prognostic models were collected. The primary outcome was postoperative AKI, defined based on the Kidney Disease Improving Global Outcome (KDIGO) Clinical Practice Guideline for AKI, in 2012.
  
  
  
  102 patients (28.9%) developed postoperative AKI. For AKI prediction, EuroSCORE II, STS score and ACEF score were all good tools for stage-3 AKI. The ACEF score was shown to have satisfied discriminant ability to predict postoperative AKI with area under a receiver operating characteristic curve: 0.781±0.027, (95% CI 0.729 to 0.834, p value <0.001). Multivariate logistic analysis identified that lower ejection fraction and higher serum creatinine were independent risk factors for AKI.
  
  
  
  The simple and extremely user-friendly ACEF score can accurately identify the risk of postoperative AKI and has shown satisfactory discriminant ability when compared with other systems. The ACEF score might be the easiest tool for predicting postoperative AKI.
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Shao-Wei
authors.initials: SW
authors.lastname: Chen
authors.affiliation: Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan Department of Nephrology, Kidney Research Center, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan.
authors.forename: Chih-Hsiang
authors.initials: CH
authors.lastname: Chang
authors.affiliation: Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan Department of Nephrology, Kidney Research Center, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan.
authors.forename: Pei-Chun
authors.initials: PC
authors.lastname: Fan
authors.affiliation: Department of Nephrology, Kidney Research Center, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan.
authors.forename: Yung-Chang
authors.initials: YC
authors.lastname: Chen
authors.affiliation: Department of Cardiology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan.
authors.forename: Pao-Hsien
authors.initials: PH
authors.lastname: Chu
authors.affiliation: Department of Cardiology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan.
authors.forename: Tien-Hsing
authors.initials: TH
authors.lastname: Chen
authors.affiliation: Department of Cardiology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan.
authors.forename: Victor Chien-Chia
authors.initials: VC
authors.lastname: Wu
authors.affiliation: Clinical Informatics and Medical Statistics Research Center, Taoyuan, Taiwan.
authors.forename: Su-Wei
authors.initials: SW
authors.lastname: Chang
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan.
authors.forename: Pyng-Jing
authors.initials: PJ
authors.lastname: Lin
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan.
authors.forename: Feng-Chun
authors.initials: FC
authors.lastname: Tsai
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis* / Q000209:etiology; D000368:Aged; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D003324:Coronary Artery Disease / Q000601:surgery; D003404:Creatinine / Q000097:blood; D005260:Female; D006801:Humans; D007677:Kidney Function Tests; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000175:diagnosis* / Q000209:etiology; D011379:Prognosis; D012372:ROC Curve; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D012720:Severity of Illness Index; D013624:Taiwan
chemical_list: D003404:Creatinine
keywords: Coronary artery bypass grafting; acute kidney injury; coronary artery disease