Chertow et al used classification tree (CART) to identify patients at risk for acute renal failure (ARF) following cardiac surgery, based on preoperative factors. This can help identify patients who may require more aggressive management. The authors are from
Parameters:
(1) creatinine clearance in mL per minute
(2) history of prior heart surgery
(3) NYHA functional status
(4) valvular surgery being done
(5) intra-aortic balloon pump (IABP) in use
(6) cardiomegaly
(7) peripheral vascular disease (PVD)
For patients with a creatinine clearance >= 60 mL/min
History of Heart Surgery |
Valvular Surgery |
NYHA |
Node in Tree |
---|---|---|---|
Y |
NA |
not IV |
C |
Y |
NA |
IV |
D |
N |
N |
NA |
B |
N |
Y |
not IV |
E |
N |
Y |
IV |
F |
For patients with a creatinine clearance < 60 mL/min
IABP |
Cardiomegaly |
NYHA |
PVD |
Valvular Surgery |
Node in Tree |
---|---|---|---|---|---|
Y |
NA |
NA |
NA |
NA |
A |
N |
Y |
not IV |
NA |
NA |
H |
N |
Y |
IV |
NA |
NA |
I |
N |
N |
NA |
N |
NA |
G |
N |
N |
NA |
Y |
N |
J |
N |
N |
NA |
Y |
Y |
K |
Node in Tree |
Percent ARF in Derivation Set |
---|---|
A |
9.5% |
B |
0.4% |
C |
1.3% |
D |
2.8% |
E |
0.9% |
F |
2.1% |
G |
1.1% |
H |
2.3% |
I |
5% |
J |
2.1% |
K |
6.1% |
where:
• In the validation set node A had 3.2% ARF; F 4.4%; H 4.9%.
Purpose: To predict the risk of a patient developing acute renal failure following cardiac surgery using the model of Chertow et al.
Specialty: Nephrology, Clinical Laboratory
Objective: risk factors, severity, prognosis, stage
ICD-10: N17-N19,