A Predictive Model for Assessing Surgery-Related Acute Kidney Injury Risk in Hypertensive Patients: A Retrospective Cohort Study.
BACKGROUND
Acute kidney injury (AKI) is a serious post-surgery complication; however, few preoperative risk models for AKI have been developed for hypertensive patients undergoing general surgery. Thus, in this study involving a large Chinese cohort, we developed and validated a risk model for surgery-related AKI using preoperative risk factors.


RESULTS
This retrospective cohort study included 24,451 hypertensive patients aged ≥18 years who underwent general surgery between 2007 and 2015. The endpoints for AKI classification utilized by the KDIGO (Kidney Disease: Improving Global Outcomes) system were assessed. The most discriminative predictor was selected using Fisher scores and was subsequently used to construct a stepwise multivariate logistic regression model, whose performance was evaluated via comparisons with models used in other published works using the net reclassification index (NRI) and integrated discrimination improvement (IDI) index.


RESULTS
Surgery-related AKI developed in 1994 hospitalized patients (8.2%). The predictors identified by our Xiang-ya Model were age, gender, eGFR, NLR, pulmonary infection, prothrombin time, thrombin time, hemoglobin, uric acid, serum potassium, serum albumin, total cholesterol, and aspartate amino transferase. The area under the receiver-operating characteristic curve (AUC) for the validation set and cross validation set were 0.87 (95% CI 0.86-0.89) and (0.89; 95% CI 0.88-0.90), respectively, and was therefore similar to the AUC for the training set (0.89; 95% CI 0.88-0.90). The optimal cutoff value was 0.09. Our model outperformed that developed by Kate et al., which exhibited an NRI of 31.38% (95% CI 25.7%-37.1%) and an IDI of 8% (95% CI 5.52%-10.50%) for patients who underwent cardiac surgery (n = 2101).


CONCLUSIONS
We developed an AKI risk model based on preoperative risk factors and biomarkers that demonstrated good performance when predicting events in a large cohort of hypertensive patients who underwent general surgery.
Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, 410013, The People's Republic of China.
Xing
X
Liu
School of Computer, National University of Defense Technology, Changsha, 410073, The People's Republic of China.
Yongkai
Y
Ye
Department of Sports Medicine and Nutrition, University of Pittsburgh, PA, 15260, United States of America.
Qi
Q
Mi
Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, 410013, The People's Republic of China.
Wei
W
Huang
Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, 410013, The People's Republic of China.
Ting
T
He
Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, 410013, The People's Republic of China.
Pin
P
Huang
Center of Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Changsha, 410013, The People's Republic of China.
Nana
N
Xu
Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, 410013, The People's Republic of China.
Qiaoyu
Q
Wu
Information Department, The Third Xiangya Hospital, Central South University, Changsha, 410013, The People's Republic of China.
Anli
A
Wang
Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, 410013, The People's Republic of China.|Center of Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Changsha, 410013, The People's Republic of China.
Ying
Y
Li
Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, 410013, The People's Republic of China.|Center of Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Changsha, 410013, The People's Republic of China.
Hong
H
Yuan
D058186:Acute Kidney Injury / Q000097:blood / Q000209:etiology*; D000328:Adult; D000368:Aged; D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood; D005260:Female; D006801:Humans; D006973:Hypertension / Q000097:blood / Q000150:complications* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000097:blood / Q000209:etiology*; D012372:ROC Curve; D012189:Retrospective Studies; D012307:Risk Factors; D013514:Surgical Procedures, Operative / Q000009:adverse effects*; D016896:Treatment Outcome
D015415:Biomarkers