The Establishment Of PO-AKI Predictive Model And The Predictive Value Of Pre-Operative N-Terminal Pro-B-Type Natriuretic Peptide In The Risk Of Acute Kidney Injury After Non-Cardiac Surgery

Objective: To evaluate the association between N-terminal pro-B-type natriuretic peptide(NT-pro BNP)with risk of postoperative AKI(PO-AKI).Methods: The electronic medical records and laboratory results were obtained from 4754 adult patients(≥18years)undergoing non-cardiac surgery performed between 1 October 2012 to 1 October 2019 at the Third Xiangya Hospital,Central South University,China.Perioperative data were analyzed retrospectively.Results: In all,5.29%(209 of 3949)of patients developed PO-AKI.Preoperative NT-pro BNP was an independent predictor of PO-AKI.After adjustment for clinical variables,OR for AKI of highest and lowest NT-pro BNP quintiles was 1.96(95% CI,1.04 to 3.68,P=0.0075),OR per1-unit increment in natural log transformed NT-pro BNP was 1.20(95%CI,1.09 to 1.32,P=0.0002).Compared with clinical variables alone,the addition of NT-pro BNP modestly improved the discrimination(change in area under the curve from 0.82 to 0.83,ΔAUC=0.01,P=0.024)and the reclassification(continuous net reclassification improvement 0.15,95%CI,0.012 to 0.287,P=0.034,improved integrated discrimination 0.01,95% CI,0.002 to 0.02,P=0.017)of AKI and non-AKI cases.Conclusions: Results from our retrospective cohort showed that the addition of preoperative NT-pro BNP concentrations could better predict postoperative AKI in a cohort of non-cardiac surgery patients and get higher net benefit in decision curve analysis.