Cardiac surgery-associated acute kidney injury: risk factors analysis and comparison of prediction models.

Kristović, Darko and Horvatić, Ivica and Husedžinović, Ino and Sutlić, Željko and Rudež, Igor and Barić, Davor and Unić, Daniel and Blažeković, Robert and Crnogorac, Matija (2015) Cardiac surgery-associated acute kidney injury: risk factors analysis and comparison of prediction models. Interactive CardioVascular and Thoracic Surgery, 21 (3). pp. 366-73. ISSN 1569-9293

[img] PDF
Download (277kB)


OBJECTIVES: Cardiac surgery-associated acute kidney injury (AKI) is a well-known factor influencing patients' long-term morbidity and mortality. Several prediction models of AKI requiring dialysis (AKI-D) have been developed. Only a few direct comparisons of these models have been done. Recently, a new, more uniform and objective definition of AKI has been proposed [Kidney Disease: Improve Global Outcomes (KDIGO)-AKI]. The performance of these prediction models has not yet been tested. ----- METHODS: Preoperative demographic and clinical characteristics of 1056 consecutive adult patients undergoing cardiac surgery were collected retrospectively for the period 2012-2014. Multivariable logistic regression analysis was used to determine the independent predictors of AKI-D and the KDIGO-AKI stages. Risk scores of five prediction models were calculated using corresponding subgroups of patients. The discrimination of these models was calculated by the c-statistics (area under curve, AUC) and the calibration was evaluated for the model with the highest AUC by calibration plots. ----- RESULTS: The incidence of AKI-D was 3.5% and for KDIGO-AKI 23% (17.3% for Stage 1, 2.1% for Stage 2 and 3.6% for Stage 3). Older age, atrial fibrillation, NYHA class III or IV heart failure, previous cardiac surgery, higher preoperative serum creatinine and endocarditis were independently associated with the development of AKI-D. For KDIGO-AKI, higher body mass index, older age, female gender, chronic obstructive pulmonary disease, previous cardiac surgery, atrial fibrillation, NYHA class III or IV heart failure, higher preoperative serum creatinine and the use of cardiopulmonary bypass were independent predictors. The model by Thakar et al. showed the best performance in the prediction of AKI-D (AUC 0.837; 95% CI = 0.810-0.862) and also in the prediction of KDIGO-AKI stage 1 and higher (AUC = 0.731; 95% CI = 0.639-0.761), KDIGO-AKI stage 2 and higher (AUC = 0.811; 95% CI = 0.783-0.838) and for KDIGO-AKI stage 3 (AUC = 0.842; 95% CI = 0.816-0.867). ----- CONCLUSIONS: The performance of known prediction models for AKI-D was found reasonably well in the prediction of KDIGO-AKI, with the model by Thakar having the highest predictive value in the discrimination of patients with risk for all KDIGO-AKI stages.

Item Type: Article
Additional Information: © The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
Departments: Katedra za kirurgiju
Depositing User: Marijan Šember
Status: Published
Kristović, DarkoUNSPECIFIED
Horvatić, IvicaUNSPECIFIED
Husedžinović, InoUNSPECIFIED
Blažeković, RobertUNSPECIFIED
Crnogorac, MatijaUNSPECIFIED
Date: September 2015
Date Deposited: 17 Feb 2016 12:00
Last Modified: 17 Feb 2016 12:00
Subjects: /
Related URLs:

Actions (login required)

View Item View Item


Downloads per month over past year