title: Dynamic Predictive Scores for Cardiac Surgery-Associated Acute Kidney Injury.
abstract: Cardiac surgery-associated acute kidney injury (CSA-AKI) is a common complication with a poor prognosis. In order to identify modifiable perioperative risk factors for AKI, which existing risk scores are insufficient to predict, a dynamic clinical risk score to allow clinicians to estimate the risk of CSA-AKI from preoperative to early postoperative periods is needed.
  
  
  
  A total of 7233 cardiac surgery patients in our institution from January 2010 to April 2013 were enrolled prospectively and distributed into 2 cohorts. Among the derivation cohort, logistic regression was used to analyze CSA-AKI risk factors preoperatively, on the day of ICU admittance and 24 hours after ICU admittance. Sex, age, valve surgery combined with coronary artery bypass grafting, preoperative NYHA score >2, previous cardiac surgery, preoperative kidney (without renal replacement therapy) disease, intraoperative cardiopulmonary bypass application, intraoperative erythrocyte transfusions, and postoperative low cardiac output syndrome were identified to be associated with CSA-AKI. Among the other 1152 patients who served as a validation cohort, the point scoring of risk factor combinations led to area under receiver operator characteristics curves (AUROC) values for CSA-AKI prediction of 0.74 (preoperative), 0.75 (on the day of ICU admission), and 0.82 (postoperative), and Hosmer-Lemeshow goodness-of-fit tests revealed a good agreement of expected and observed CSA-AKI rates.
  
  
  
  The first dynamic predictive score system, with Kidney Disease: Improving Global Outcomes (KDIGO) AKI definition, was developed and predictive efficiency for CSA-AKI was validated in cardiac surgery patients.
authors: Department of Nephrology, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai, China Shanghai Kidney and Dialysis Institute, Shanghai, China.
authors: Wuhua
authors: W
authors: Jiang
authors: Department of Nephrology, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai, China Shanghai Kidney and Dialysis Institute, Shanghai, China Shanghai Kidney and Blood Purification Laboratory, Shanghai, China.
authors: Jie
authors: J
authors: Teng
authors: Department of Nephrology, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai, China Shanghai Kidney and Dialysis Institute, Shanghai, China.
authors: Jiarui
authors: J
authors: Xu
authors: Department of Nephrology, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai, China Shanghai Kidney and Dialysis Institute, Shanghai, China.
authors: Bo
authors: B
authors: Shen
authors: Department of Nephrology, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai, China Shanghai Kidney and Dialysis Institute, Shanghai, China.
authors: Yimei
authors: Y
authors: Wang
authors: Department of Nephrology, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai, China Shanghai Kidney and Dialysis Institute, Shanghai, China Shanghai Kidney and Blood Purification Laboratory, Shanghai, China.
authors: Yi
authors: Y
authors: Fang
authors: Department of Nephrology, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai, China Shanghai Kidney and Dialysis Institute, Shanghai, China.
authors: Zhouping
authors: Z
authors: Zou
authors: Department of Nephrology, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai, China Shanghai Kidney and Dialysis Institute, Shanghai, China.
authors: Jifu
authors: J
authors: Jin
authors: Department of Cardiac Surgery Intensive Care Unit, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.
authors: Yamin
authors: Y
authors: Zhuang
authors: Department of Cardiac Surgery Intensive Care Unit, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.
authors: Lan
authors: L
authors: Liu
authors: Department of Cardiac Surgery Intensive Care Unit, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.
authors: Zhe
authors: Z
authors: Luo
authors: Department of Cardiovascular Surgery, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.
authors: Chunsheng
authors: C
authors: Wang
authors: Department of Nephrology, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai, China Shanghai Kidney and Dialysis Institute, Shanghai, China Shanghai Kidney and Blood Purification Laboratory, Shanghai, China ding.xiaoqiang@zs-hospital.sh.cn.
authors: Xiaoqiang
authors: X
authors: Ding
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology*; D000367:Age Factors; D000368:Aged; D002303:Cardiac Output, Low / Q000150:complications; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D001026:Coronary Artery Bypass / Q000009:adverse effects; D017707:Erythrocyte Transfusion / Q000009:adverse effects; D005260:Female; D006351:Heart Valves / Q000601:surgery; D006801:Humans; D007674:Kidney Diseases / Q000150:complications; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012372:ROC Curve; D012307:Risk Factors; D012737:Sex Factors
keywords: acute kidney injury; cardiac surgery; risk factor; risk score