Bell et al developed a model for predicting acute kidney injury (AKI) in patients undergoing orthopedic surgery. This can help to identify a patient who may benefit from more aggressive management. The authors are from Ninewells Hospital, Leiden University Medical Centre, and the University of Dundee.
Patient selection: Scottish adults undergoing orthopedic surgery
Outcome: any degree of acute kidney injury during first postoperative week (increase in serum creatinine concentration >= 26.4 µmol/L from preoperative OR postoperative creatinine > 1.5 times preoperative baseline)
Parameters:
(1) gender
(2) age in years at time of operation
(3) diabetes mellitus
(4) number of prescribed drugs
(5) therapy with ACE inhibitor or angiotensin receptor blocker
(6) baseline eGFR in mL per minute based on the CKD-EPI equation
(7) ASA grade for surgery
|
Parameter |
Finding |
Beta Coefficient |
|
gender |
male |
0 |
|
|
female |
-0.708 |
|
age in years |
|
0.022 * (age) |
|
diabetes |
no |
0 |
|
|
yes |
0.427 |
|
prescribed drugs |
0 |
0 |
|
|
1 or 2 |
0.130 |
|
|
>= 3 |
0.347 |
|
ACE inhibitor or angiotensin receptor blocker |
no |
0 |
|
|
yes |
0.534 |
|
eGFR |
> 60 mL per min |
-1.417 |
|
|
45 to 59 mL per min |
-1.108 |
|
|
30 to 44 mL per min |
-0.676 |
|
|
< 29 mL per min |
0 |
|
ASA |
ASA 1 |
-1.037 |
|
|
ASA 2 |
-0.141 |
|
|
ASA 3 |
0.014 |
|
|
ASA 4 |
0 |
X =
= SUM(beta coefficient) – 2.385
probability of AKI =
= 1 / (1 + EXP((-1) * X))
Performance:
• The area under the ROC sucrve was 0.74 in the development and 0.70 in the validation cohorts.
Limitatons:
• The study is based on an observational cohort study.
Purpose: To determine the risk of acute kidney injury following orthopedic surgery using the model of Bell et al.
Specialty: Nephrology, Clinical Laboratory
Objective: complications, surgery
ICD-10: S37.0,
