From the Faculty of Medicine, Department of Laboratory Medicine, Children's and Women's Health (KSB, VV), Department of Circulation and Medical Imaging (RS, AW), Norwegian University of Science and Technology, Department of Cardiothoracic Anaesthesia and Intensive Care (RS, HP), Department of Cardiothoracic Surgery (AW) and Department of Immunology and Transfusion Medicine (HP, VV), St Olav's University Hospital, Trondheim, Norway.
Eur J Anaesthesiol. 2013 Nov;30(11):704-12. doi: 10.1097/EJA.0b013e328365ae64.
Several models for predicting acute kidney injury following cardiac surgery have been published, and various end-point definitions have been used.
Our aim was to investigate how acute kidney injury following cardiac surgery could be most accurately predicted.
Single-centre prospective observational study.
St Olav's University Hospital, Trondheim, Norway, from 2000 to 2007.
All 5029 adult patients undergoing cardiac surgery were considered eligible for participation. Patients who required preoperative dialysis and patients with missing information on preoperative or maximum postoperative serum creatinine concentration were excluded (n=51). A total of 4978 patients were entered into the statistical analyses.
Logistic regression with bootstrapping methods was applied for model development and validation, together with the area under the receiver operating characteristic curve and Hosmer-Lemeshow test. We tested different end-points, exchanged serum creatinine concentration with creatinine clearance or estimated glomerular filtration rate and added intraoperative variables. The main end-point was at least 50% increase in serum creatinine concentration, an increase in concentration by at least 26.4 μmol l(-1) (0.3 mg dl(-1)) or a new requirement for dialysis after surgery.
The final model consisted of 11 preoperative predictors of acute kidney injury: age, BMI, lipid-lowering treatment, hypertension, peripheral vascular disease, chronic pulmonary disease, haemoglobin concentration, serum creatinine concentration, previous cardiac surgery, emergency operation and operation type. The area under the receiver operating characteristic curve was 0.819 (95% confidence interval 0.801 to 0.837), and the Hosmer-Lemeshow test P value was 0.17. Exchanging serum creatinine concentration with glomerular filtration rate or creatinine clearance slightly reduced model discrimination and the addition of intraoperative variables improved discrimination somewhat. Slight end-point definition changes had little impact.
The risk of acute kidney injury can be accurately predicted using preoperative variables. Serum creatinine concentration was more accurate than estimated glomerular filtration rate or creatinine clearance. Intraoperative variables slightly improved the model, but did not seem to outweigh the advantages of a preoperative model.
已经发表了几种用于预测心脏手术后急性肾损伤的模型，并且使用了各种终点定义。
我们旨在研究如何最准确地预测心脏手术后的急性肾损伤。
单中心前瞻性观察性研究。
挪威特隆赫姆的圣奥拉夫大学医院，2000 年至 2007 年。
所有接受心脏手术的 5029 名成年患者均被认为有资格参加。排除需要术前透析的患者和术前或最大术后血清肌酐浓度信息缺失的患者（n=51）。共有 4978 名患者进入统计分析。
应用逻辑回归和自举法进行模型开发和验证，同时应用受试者工作特征曲线下面积和 Hosmer-Lemeshow 检验。我们测试了不同的终点，将血清肌酐浓度与肌酐清除率或估计肾小球滤过率交换，并加入术中变量。主要终点是血清肌酐浓度至少增加 50%，浓度至少增加 26.4μmol l(-1)（0.3mg dl(-1)）或手术后需要新的透析。
最终模型包括 11 个术前急性肾损伤预测因素：年龄、BMI、降脂治疗、高血压、外周血管疾病、慢性肺部疾病、血红蛋白浓度、血清肌酐浓度、先前的心脏手术、急诊手术和手术类型。受试者工作特征曲线下面积为 0.819（95%置信区间 0.801 至 0.837），Hosmer-Lemeshow 检验 P 值为 0.17。将血清肌酐浓度与肾小球滤过率或肌酐清除率交换会略微降低模型的区分度，并且添加术中变量会略微改善区分度。终点定义的轻微变化几乎没有影响。
可以使用术前变量准确预测急性肾损伤的风险。血清肌酐浓度比估计的肾小球滤过率或肌酐清除率更准确。术中变量略微改善了模型，但似乎并没有超过术前模型的优势。
