Malov Andrey A, Borisov Alexander S, Lomivorotov Vladimir V, Efremov Sergey M, Ponomarev Dmitry N, Mukhoedova Tamara V, Karaskov Alexander M
Department of Anesthesiology and Intensive Care, Research Institute of Circulation Pathology, Novosibirsk, Russian Federation.
Department of Anesthesiology and Intensive Care, Research Institute of Circulation Pathology, Novosibirsk, Russian Federation.
Heart Lung Circ. 2014 Apr;23(4):325-31. doi: 10.1016/j.hlc.2013.10.082. Epub 2013 Oct 25.
To build a predictive model for patients with dialysis-dependent acute kidney injury (AKI-D) after cardiac surgery with the cardiopulmonary bypass (CPB), according to disease severity.
A single-centre, retrospective cohort study was performed to determine the demographic and clinical parameters (including the specific factor, CPB duration) for risk of poor outcome in patients requiring RRT after cardiac surgery with CPB. A new model was built for mortality prediction in these patients on the basis of the identified risk factors and Sequential Organ Failure Assessment score.
The newly developed model showed good discriminatory ability for predicting death in patients with AKI-D after cardiac surgery with CPB. The area under the receiver-operating characteristic (ROC) curve for the score was 0.892 (95% confidence interval, 0.852-0.925). We also determined the criterion for the choice of RRT modality by applying this model. On applying the new model in intermittent haemodialysis patients, a score of ≤3.2 was found safe for selecting the RRT modality.
The new scoring system was valid and accurate in predicting death for AKI-D patients after open-heart surgery. This system and value for choice of RRT were determined for guidance only, to facilitate decision-making in difficult situations.
根据疾病严重程度，构建体外循环心脏手术后依赖透析的急性肾损伤（AKI-D）患者的预测模型。
进行一项单中心回顾性队列研究，以确定体外循环心脏手术后需要肾脏替代治疗（RRT）的患者不良结局风险的人口统计学和临床参数（包括特定因素，体外循环持续时间）。基于识别出的危险因素和序贯器官衰竭评估评分，为这些患者构建一个新的死亡预测模型。
新开发的模型对预测体外循环心脏手术后AKI-D患者的死亡具有良好的鉴别能力。该评分的受试者工作特征（ROC）曲线下面积为0.892（95%置信区间，0.852 - 0.925）。我们还通过应用该模型确定了RRT模式选择的标准。在间歇性血液透析患者中应用新模型时，发现评分≤3.2选择RRT模式是安全的。
新的评分系统在预测心脏直视手术后AKI-D患者的死亡方面是有效且准确的。该系统和RRT选择值仅用于指导，以便在困难情况下促进决策。
