Division of Hospital Medicine, Department of Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania.
Division of Nephrology, Department of Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania.
Kidney360. 2020 Dec 29;2(2):215-223. doi: 10.34067/KID.0004732020. eCollection 2021 Feb 25.
AKI after surgery is associated with high mortality and morbidity. The purpose of this study is to develop and validate a risk prediction tool for the occurrence of postoperative AKI requiring RRT (AKI-dialysis).
This retrospective cohort study had 2,299,502 surgical patients over 2015-2017 from the American College of Surgeons National Surgical Quality Improvement Program Database (ACS NSQIP). Eleven predictors were selected for the predictive model: age, history of congestive heart failure, diabetes, ascites, emergency surgery, hypertension requiring medication, preoperative serum creatinine, hematocrit, sodium, preoperative sepsis, and surgery type. The predictive model was trained using 2015-2016 data (=1,487,724) and further tested using 2017 data (=811,778). A risk model was developed using multivariable logistic regression.
AKI-dialysis occurred in 0.3% (=6853) of patients. The unadjusted 30-day postoperative mortality rate associated with AKI-dialysis was 37.5%. The AKI risk prediction model had high area under the receiver operating characteristic curve (AUC; training cohort: 0.89, test cohort: 0.90) for postoperative AKI-dialysis.
This model provides a clinically useful bedside predictive tool for postoperative AKI requiring dialysis.
手术后急性肾损伤(AKI)与高死亡率和高发病率相关。本研究旨在开发和验证一种预测术后需要肾脏替代治疗(AKI-透析)的 AKI 发生风险的工具。
本回顾性队列研究纳入了 2015 年至 2017 年期间美国外科医师学会国家外科质量改进计划数据库(ACS NSQIP)中的 2299502 例手术患者。选择了 11 个预测因素用于预测模型:年龄、充血性心力衰竭史、糖尿病、腹水、急诊手术、需要药物治疗的高血压、术前血清肌酐、血细胞比容、钠、术前脓毒症和手术类型。使用 2015-2016 年的数据(=1487724)对预测模型进行训练,并进一步使用 2017 年的数据(=811778)进行测试。使用多变量逻辑回归开发风险模型。
AKI-透析在 0.3%(=6853)的患者中发生。未调整的 AKI-透析术后 30 天死亡率为 37.5%。AKI 风险预测模型对术后 AKI-透析具有较高的接受者操作特征曲线下面积(AUC;训练队列:0.89,测试队列:0.90)。
该模型为术后需要透析的 AKI 提供了一种具有临床实用价值的床边预测工具。