Division of Cardiovascular Surgery, Mayo Clinic, Rochester, MN 55905, USA.
Am J Kidney Dis. 2010 Oct;56(4):623-31. doi: 10.1053/j.ajkd.2010.04.017. Epub 2010 Jul 13.
Acute kidney injury (AKI) requiring renal replacement therapy (RRT) in patients undergoing cardiac surgery is associated strongly with adverse patient outcomes. Recently, 3 predictive risk models for RRT have been developed. The aims of our study are to validate the predictive scoring models for patients requiring postoperative RRT and test applicability to the broader spectrum of patients with postoperative severe AKI.
Diagnostic test study.
SETTING & PARTICIPANTS: 12,096 patients undergoing cardiac surgery with cardiopulmonary bypass at Mayo Clinic, Rochester, MN, from 2000 through 2007.
Cleveland Clinic score, Mehta score, and Simplified Renal Index (SRI) score.
Incidence of postoperative RRT or composite outcome of severe AKI, defined as serum creatinine level >2.0 mg/dL, and a 2-fold increase compared with the preoperative baseline creatinine level or RRT.
RRT was used in 254 (2.1%) patients, whereas severe AKI was present in 467 (3.9%). Discrimination for the prediction of RRT and severe AKI was good for all scoring models measured using areas under the receiver operating characteristic curve (AUROCs): 0.86 (95% CI, 0.84-0.88) for RRT and 0.81 (95% CI, 0.79-0.83) for severe AKI using the Cleveland score, 0.81 (95% CI, 0.78-0.86) and 0.76 (95% CI, 0.73-0.80) using the Mehta score, and 0.79 (95% CI, 0.77-0.82) and 0.75 (95% CI, 0.72-0.77) using the SRI score. The Cleveland score and Mehta score consistently showed significantly better discrimination compared with the SRI score (P < 0.001). Despite lower AUROCs for the prediction of severe AKI, the Cleveland score AUROC was still >0.80. The Mehta score is applicable in only a subgroup of patients.
Single-center retrospective cohort study.
The Cleveland scoring system offers the best discriminative value to predict postoperative RRT and covers most patients undergoing cardiac surgery. It also can be used for prediction of the composite end point of severe AKI, which enables broader application to patients at risk of postoperative kidney dysfunction.
心脏手术后需要肾脏替代治疗（RRT）的急性肾损伤（AKI）与患者不良预后密切相关。最近，已经开发出 3 种预测 RRT 的风险模型。我们的研究目的是验证用于术后需要 RRT 的患者的预测评分模型，并测试其在术后严重 AKI 更广泛患者群体中的适用性。
诊断测试研究。
2000 年至 2007 年在明尼苏达州罗切斯特市梅奥诊所接受心肺旁路手术的 12096 名患者。
克利夫兰诊所评分、Mehta 评分和简化肾脏指数（SRI）评分。
术后 RRT 的发生率或严重 AKI 的复合结局，定义为血清肌酐水平>2.0mg/dL，与术前基线肌酐水平或 RRT 相比增加 2 倍。
254 名（2.1%）患者使用了 RRT，467 名（3.9%）患者出现严重 AKI。使用接受者操作特征曲线（AUROC）下面积测量，所有评分模型对 RRT 和严重 AKI 的预测均具有良好的区分度：克利夫兰评分的 RRT 为 0.86（95%CI，0.84-0.88），严重 AKI 为 0.81（95%CI，0.79-0.83），Mehta 评分的 RRT 为 0.81（95%CI，0.78-0.86），严重 AKI 为 0.76（95%CI，0.73-0.80），SRI 评分的 RRT 为 0.79（95%CI，0.77-0.82），严重 AKI 为 0.75（95%CI，0.72-0.77）。克利夫兰评分和 Mehta 评分与 SRI 评分相比，始终显示出更好的区分度（P<0.001）。尽管预测严重 AKI 的 AUROC 较低，但克利夫兰评分的 AUROC 仍>0.80。Mehta 评分仅适用于患者的亚组。
单中心回顾性队列研究。
克利夫兰评分系统对预测术后 RRT 具有最佳的区分能力，可涵盖大多数接受心脏手术的患者。它还可用于预测严重 AKI 的复合终点，从而更广泛地应用于术后肾功能障碍风险患者。
