The Derivation And Validation Of Prediction Scores For Acute Kidney Injury Following Adult Cardiac Surgery

Background:Acute kidney injury(AKI)is a common complication after cardiac surgery.The derivation of a clinical prediction model is not only helpful for screening high-risk groups of AKI and predicting the risk of AKI after surgery,but also has important significance for exploring the prevention and treatment measures of AKI.At present,the researches about AKI prediction models are mainly concentrated in European and American races.After external validation using data from other clinical centers,it is found that these models are not ideal.And the reasons are not clear.Studies have confirmed that foreign prediction models cannot be directly applied to the Chinese population,and there are few domestic related studies,all of which are small-sample studies.Therefore,it is very necessary to develop a postoperative AKI risk prediction model suitable for cardiac surgery patients in Chinese population.Objectives:This study was performed to internally derive and then validate risk score systems using pre-and intraoperative variables to predict the occurrence of acute kidney injury(AKI)and stage-3 AKI of cardiac surgery.Methods:Retrospectively obtained 58399 patients undergoing open cardiac surgery clinical data,then divided into two groups:a derivation cohort(n=43799)and a validation cohort(n=14600).AKI was defined using the Kidney Disease Improving Global Outcomes(KDIGO)criteria.Multivariable logistic regression analysis was used to develop the prediction models.Results:The overall prevalences of AKI and stage-3 AKI within 7 days of cardiac surgery were 34.3%and 1.7%,respectively.The discriminatory ability of the AKI prediction model measured by the area under the curve(AUC)was acceptable(AUC=0.69,95%confidence interval[CI]0.68,0.69),and the calibration measured by the Hosmer-Lemeshow test was good(P=0.95).Similarly,the discriminatory ability and calibration for the stage-3 AKI prediction model was also good(AUC=0.84,95%CI 0.83-0.85;Hosmer-Lemeshow test:P=0.73).Conclusions:Our research,using pre-and intra-operative variables,derived and internally validated two predictive scoring systems for AKI and stage-3 AKI.Objective:To investigate the association between preoperative serum high sensitive C-reactive protein(hs-CRP)and acute kidney injury(AKI)after adult cardiac surgery.Methods:Adult patients underwent cardiac surgery from Jan 1,2017 to Dec 31,2018 were enrolled into our retrospective study.AKI was defined according to Kidney Disease:Improving Global Outcomes(KDIGO)criteria.The Logistic regression analysis was used to analyze the association between preoperative hs-CRP and AKI.Results:Among the 17339 adult patients,the overall prevalence of AKI after cardiac surgery was 30.1%(n=5231).There were 4350 patients(25.1%)whose preoperative serum hs-CRP more than 3 mg/L.The proportion of AKI patients with hs-CRP>3mg/L before operation was significantly higher than that of non-AKI patients(30.5%vs 24.8%P<0.001).After adjusting the affection of age,sex,past history,preoperative cardiac function,preoperative renal function,intraoperative blood transfusion and other covariates,the multivariable Logistic regression analysis showed that preoperative serum hs-CRP more than 3 mg/L was an independent risk factor of AKI after cardiac surgery(OR=1.145,95%CI 1.052-1.246,P=0.002).Conclusion:Preoperative serum hs-CRP more than 3 mg/L can increase the probability of occurrence of AKI after adult cardiac surgery.