PMID- 31243735 OWN - NLM STAT- MEDLINE DCOM- 20200909 LR - 20211112 IS - 1724-6059 (Electronic) IS - 1121-8428 (Linking) VI - 32 IP - 6 DP - 2019 Dec TI - Risk factors of cardiac surgery-associated acute kidney injury: development and validation of a perioperative predictive nomogram. PG - 937-945 LID - 10.1007/s40620-019-00624-z [doi] AB - OBJECTIVE: Cardiac surgery-associated acute kidney injury (CSA-AKI), one of the most severe complications in patients with cardiac surgery, is associated with considerable morbidity, mortality and high costs thus placing a heavy burden to society. Therefore, we aimed to build a predictive model based on preoperative features in order to early recognize and intervene for patients with high risk of CSA-AKI. METHODS: In this retrospective cohort study, baseline perioperative hospitalization information of patients who underwent cardiac surgery from October 2012 to October 2017 were screened. After multivariate logistic regression, identified independent predictive factors associated with CSA-AKI were incorporated into the nomogram and the discriminative ability and predictive accuracy of the model was assessed by concordance index (C-Index). Additionally, internal validation was performed by using bootstrapping technology with 1000 resamples to reduce the over-fit bias. RESULTS: In all 4395 patients with cardiac surgery October 2012-October 2017, no patients were excluded for the continuous renal replacement therapy (CRRT) before surgery while 2495 patients were excluded due to only one or less than one Scr assay post-surgery. In the end, a total of 1900 patients were enrolled in the study, of which 698 patients (74.89%) developed AKI stage 1, 158 (16.96%) AKI stage 2 and 76 (8.15%) AKI stage 3. After multivariate logistic regression, age, perioperative estimated glomerular filtration rate (eGFR), lactate dehydrogenase (LDH), prothrombin time (PT), with a history of surgery, transfusion, cardiac arrhythmia, coronary heart disease (CHD), or chronic kidney disease (CKD), using calcium channel blocker (CCB), proton pump inhibitors (PPI), non-steroidal anti-inflammatory drugs (NSAID), antibiotic or statin before surgery were predictive factors of CSA-AKI. In addition, the nomogram demonstrated a good accuracy in estimating CSA-AKI, with an C-Index and a bootstrap-corrected one of 0.796 (SD = 0.018, 95% CI 0.795-0.797) and 0.789 (SD = 0.015, 95% CI 0.788-0.790), respectively. Moreover, calibration plots showed an optimal consistency with the actual presence of CSA-AKI. CONCLUSION: The novel predictive nomogram achieved a good preoperative prediction of CSA-AKI within the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Though the model, the risk of an individual patient with "subclinical AKI" undergoing cardiac surgery could be determined earlier and such application was helpful for timely intervention in order to improve patient's prognosis. FAU - Guan, Chen AU - Guan C AD - Department of Nephrology, The Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, 266003, China. FAU - Li, Chenyu AU - Li C AD - Department of Nephrology, The Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, 266003, China. FAU - Xu, Lingyu AU - Xu L AD - Department of Nephrology, The Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, 266003, China. FAU - Zhen, Li AU - Zhen L AD - Department of Nephrology, The Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, 266003, China. FAU - Zhang, Yue AU - Zhang Y AD - Department of Nephrology, The Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, 266003, China. FAU - Zhao, Long AU - Zhao L AD - Department of Nephrology, The Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, 266003, China. FAU - Zhou, Bin AU - Zhou B AD - Department of Nephrology, The Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, 266003, China. FAU - Che, Lin AU - Che L AD - Department of Nephrology, The Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, 266003, China. FAU - Wang, Yanfei AU - Wang Y AD - Department of Nephrology, The Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, 266003, China. FAU - Xu, Yan AU - Xu Y AUID- ORCID: 0000-0003-2049-3976 AD - Department of Nephrology, The Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, 266003, China. xuyanqyfy@126.com. LA - eng GR - 81170688/National Natural Science Foundation of China/ GR - 81470973/National Natural Science Foundation of China/ GR - 81770679/National Natural Science Foundation of China/ GR - 81800601/National Natural Science Foundation of China/ PT - Journal Article PT - Observational Study DEP - 20190626 PL - Italy TA - J Nephrol JT - Journal of nephrology JID - 9012268 SB - IM MH - Acute Kidney Injury/diagnosis/epidemiology/*etiology MH - Cardiac Surgical Procedures/*adverse effects MH - China/epidemiology MH - Female MH - Follow-Up Studies MH - Glomerular Filtration Rate/*physiology MH - Humans MH - Incidence MH - Kidney/*physiopathology MH - Male MH - Middle Aged MH - *Nomograms MH - *Postoperative Complications MH - Prognosis MH - Retrospective Studies MH - Risk Assessment/*methods MH - Risk Factors OTO - NOTNLM OT - Cardiac surgery-associated acute kidney injury OT - Nomogram OT - Predictive model EDAT- 2019/06/28 06:00 MHDA- 2020/09/10 06:00 CRDT- 2019/06/28 06:00 PHST- 2019/03/20 00:00 [received] PHST- 2019/06/18 00:00 [accepted] PHST- 2019/06/28 06:00 [pubmed] PHST- 2020/09/10 06:00 [medline] PHST- 2019/06/28 06:00 [entrez] AID - 10.1007/s40620-019-00624-z [pii] AID - 10.1007/s40620-019-00624-z [doi] PST - ppublish SO - J Nephrol. 2019 Dec;32(6):937-945. doi: 10.1007/s40620-019-00624-z. Epub 2019 Jun 26.