Nah et al developed a clinical score for predicting the risk of acute kidney injury following cardiac surgery in a patient from Southeast Asia. This can help to identify a patient who may benefit from more aggressive management. The authors are from the National University of Singapore, the National University Health System, Singapore General Hospital, and Due-National University of Singapore Graduate Medical School.
Patient selection: adult in Singapore undergoing cardiac surgery, consisting of Chinese, Malay, Indian and others
Outcome: acute kidney injury
Parameters:
(1) age in years
(2) history of hypertension
(3) preoperative anemia (< 12.5 g/dL)
(4) preoperative eGFR in mL per minute (by the CKD-EPI equation)
(5) RBC transfusion during surgery
(6) use of intra-aortic balloon pump (IABP)
(7) cardiopulmonary bypass time in minutes
(8) lowest hematocrit during cardiopulmonary bypass in percent
|
Parameter |
Finding |
Score |
|
age in years |
< 65 years |
0 |
|
|
>= 65 years |
2 |
|
history of hypertension |
no |
0 |
|
|
yes |
2 |
|
preoperative anemia |
no |
0 |
|
|
yes |
2 |
|
preoperative eGFR |
>= 60 mL per minute |
0 |
|
|
< 60 mL per minute |
1 |
|
RBC transfusion during surgery |
no |
0 |
|
|
yes |
1 |
|
use of IABP |
no |
0 |
|
|
yes |
3 |
|
cardiopulmonary bypass time |
< 120 minutes |
0 |
|
|
>= 120 minutes |
2 |
|
lowest hematocrit |
>= 22% |
0 |
|
|
< 22% |
1 |
total score =
= SUM(points for all 8 parameters)
Interpretation:
• minimum score: 0
• maximum score: 14
• The higher the score the greater the risk for acute kidney injury.
|
Score |
Percent AKI |
|
0 to 4 |
15% |
|
5 to 8 |
40% |
|
9 to 14 |
73% |
Based on Figure 1:
percentage of patients with AKI =
= (6.07 * (score)) + 6
Performance:
• The area under the ROC curve ranged from 0.70 (derivation cohort) and 0.75 (validation cohort)
Specialty: Nephrology, Clinical Laboratory
